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  • Infrapatellar bursitis
  • Housemaid’s knee

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  • 726.65 Prepatellar bursitis

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  • M70.40 Prepatellar bursitis, unspecified knee

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Description

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  • Localized inflammation of the prepatellar bursa
  • Bursa fills with blood and serous fluid as response to either acute or repeated micro trauma.
  • Presents as pronounced, local swelling isolated to the anterior knee.

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Essentials of Diagnosis

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  • Result of single episode of trauma or repeat trauma to the anterior knee when in a flexed position
  • Bursitis is commonly related to occupation or specific activity that causes rubbing or pressure on the anterior knee from a hard surface.
  • Swelling is contained to bursa which results in the visualization of a swollen appearance on both sides of the patella tendon.
  • Patients often note focal pain to palpation of swollen bursa, decreased range of motion, or inability to bear weight on the flexed knee.
  • Differential diagnosis is essential due to presence of infections to this area.
  • Exquisite swelling, marked tenderness, and redness or heat may be indicative of differential diagnosis.
  • When chronic, often associated with occupation (maid) or prolonged activity (tile installer) which places flexed knee on hard surface
  • When acute, often associated with acute blow when the knee is flexed (athletes)

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General Considerations

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  • Full history of symptoms and medical history screening will ensure appropriate diagnosis.
  • Isolated diagnosis related to acute or chronic activity (pressure to the anterior flexed knee by a hard surface) and focal swelling/pain
  • Marked tenderness or swelling with acute onset may signal underlying fracture.
  • Redness or heat may be indicative of infection.

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Demographics

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  • Occurs primarily in adults but can occur in children and athletes of any age

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Signs and Symptoms

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  • Point tenderness to the anterior knee
  • Focal swelling
  • Stiffness with flexion
  • Pain with rubbing or light pressure to the anterior knee
  • Pain with focal pressure
  • Knee ROM (usually flexion) can be reduced
  • Pain and swelling can be either insidious or acute
    • Occasionally, swelling can be spontaneous and without pain
  • Possible reduction in strength due to pain and inflammation.
  • Pain in anterior knee
  • Increased swelling throughout the day
  • Tenderness changes position with tendon movement during extension
  • Thickening of the tendon
  • Decreased extension strength

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Functional Implications

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  • Inability to climb stairs or ladder
  • Inability to push-off during ambulation
  • Decreased ability to kneel
  • Decreased squat depth

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Possible Contributing Causes

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  • Intrinsic risk factors
    • Decreased knee flexion ROM
    • Decreased quadriceps strength
    • Greater pronation/calcaneal varus and faster rate of maximum pronation
    • obesity
  • Extrinsic risk factors
    • Occupational factors with kneeling and weight-bearing on the anterior knee

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Differential Diagnosis

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  • Tendon rupture
  • Tendon partial tear
  • Bone spur
  • Chondromalacia
  • Tendinitis
  • Meniscal tear
  • ACL ligament ...

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