Bursitis, prepatellar

• Infrapatellar bursitis
• Housemaid’s knee

• 726.65 Prepatellar bursitis

• M70.40 Prepatellar bursitis, unspecified knee

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

Description

• 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.

Essentials of Diagnosis

• 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)

General Considerations

• 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.

Demographics

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

Signs and Symptoms

• 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

Functional Implications

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

Possible Contributing Causes

• 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

Differential Diagnosis

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