Bursae are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
A lime-sized lump at the front of the knee may be a sign of prepatellar bursitis. Prepatellar bursitis occurs when the bursa at the front of the knee becomes inflamed and fills with excess fluid. It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.
The severity of prepatellar bursitis pain and tenderness varies – for instance, the affected knee may feel the following:
- An uncomfortable and achy feeling, even while resting, as well as tender.
- Have no pain at rest but feel tender when kneeling, bending, or just pressing on the skin over the knee.
- Having no symptoms of pain or tenderness.
The sensations of tenderness and pain may increase as the bursa swells larger over a period of time, particularly if the bursa gets squeezed during extreme bending or straightening of the leg.
Overall, an adult body contains about 140 bursae – the prepatellar bursa is generally located at the front of the knee, in between the skin and the patella bone (kneecap). It is one of the bursae most likely to develop bursitis.
Prepatellar bursitis has also been referred to as “housemaid’s knee”, “carpet layer’s knee”, “coal miner’s knee”, and “carpenter’s knee”. These nicknames arose because people whose jobs require frequent kneeling are prone to knee bursitis.
Causes & Symptoms
Prepatellar bursitis is often caused by pressure from constant kneeling. A direct blow to the front of the knee can also cause prepatellar bursitis. Athletes who participate in sports in which direct blows or falls on the knee are common, such as football, rugby, wrestling, or basketball, are at greater risk for the condition.
Other people who are more susceptible to the condition include those who are living with rheumatoid arthritis or gout. This type of knee bursitis can also be caused by a bacterial infection. If a knee injury such as an insect bite, scrape, or puncture wound may break the skin. Therefore, bacteria may get inside the bursa sac and cause an infection. This is called infectious bursitis. Infectious bursitis is less common, but more serious and must be treated more urgently. If the bursa becomes infected, the front of the knee becomes swollen, tender, and warm to the touch around the bursa. You may also experience a fever and feel chills.
As for symptoms linked to prepatellar bursitis, this condition causes pain and swelling in the area around the front of the kneecap. If the condition has been present for some time, small lumps may be felt underneath the skin over the kneecap. These lumps are usually the thickened folds of bursa tissue that have formed in response to chronic inflammation. Changes to the skin can also be a symptom linked to prepatellar bursitis, in which the skin over the affected knee may look pink or red.
Who Gets Prepatellar Bursitis?
Anyone can develop prepatellar bursitis. However, studies have shown that men are more prone to experience this condition rather than women. Additionally, men aged 40-60 years have a higher chance to be affected.
Generally, there are many other reasons why this specific bursitis can develop. While repetitive irritation, trauma, or infection may trigger prepatellar bursitis, the underlying cause cannot always be identified. Certain factors, such as underlying conditions, can increase the risk of knee bursitis.
Prepatellar bursitis is often caused by frequent mini-traumas, such as repetitive kneeling on hard surfaces. Kneeling puts pressure on the front of the knee, where the prepatellar bursa is located. Therefore, people who kneel a lot for their work, such as carpet installers, roofers, housecleaners, and clergy, may develop bursitis in their knees. Intense exercise, such as jogging or powerlifting, may also be associated with knee bursitis.
How Does It Affect You? How Serious Is It?
Trauma to the knee can be a serious risk factor leading to the development of prepatellar bursitis. An acute injury can damage the prepatellar bursa at front of the knee. When this happens, the bursa may become swollen with blood, synovial fluid, or a combination of the two. After an injury:
- The damaged prepatellar bursa may fill with blood.
- The blood irritates the bursa’s delicate lining, causing it to become inflamed.
- The blood in the prepatellar bursa may be gradually reabsorbed into the body, the bursa’s lining may stay inflamed. The inflamed lining may also produce excess synovial fluid.
- The fluid fills the bursa, causing swelling and other knee bursitis symptoms.
Experts estimate about 1/3 of prepatellar bursitis cases may be caused by an infection. When a bursa is infected the bursa sac fills with puss. This condition is called septic bursitis. And requires urgent treatment. A patient with septic prepatellar bursitis may notice the skin over the knee, including the following:
- Appears red
- Is noticeably warmer than other areas
- Looks patchy or has a rash, bumps, or sores
- A general feeling of being sick
Septic bursitis is common in the prepatellar bursa because it lies just below the skin. Bursae that lie just below the skin are called ‘superficial bursae’. Bacteria and other microorganisms typically enter a superficial bursa through a scrape or cut. Less often, microorganisms enter a bursa during an aspiration, a procedure to remove fluid from the bursa. Without treatment, the infectious microbes in the bursa may spread to other areas of the leg or the bloodstream. An infection of the bloodstream is rare but can be life-threatening. To prevent the spread of infection, experts strongly advise treating septic bursitis immediately.
Recommended Treatment & Rehabilitation
An accurate diagnosis requires ruling out other possible problems, such as rheumatoid arthritis and gout. It is also important to identify whether or not the bursitis is caused by an infection. During a medical office visit, a health care provider will talk to the patient and conduct a physical exam. Depending on the circumstances, lab testing or medical imaging may be recommended.
The patient will be asked to describe when symptoms began, the pattern of knee pain and swelling, and how symptoms affect everyday activities. A patient may also be asked about his / her general medical history, work, and lifestyle. A patient’s reported symptoms and medical history are important for diagnosis and further treatment.
A doctor will also examine the knee joint and compare it to the unaffected knee, taking note of swelling, tenderness, pain points, and range of motion. While medical imaging is not usually needed to help diagnose prepatellar bursitis, it may be recommended to rule out other conditions. For example, when bursitis occurs after an injury, an X-Ray may be ordered to rule out a broken bone. Similarly, an MRI or an ultrasound may be ordered to rule out excess fluid in the knee joint capsule. Getting an accurate diagnosis is the first step in the treatment and prevention of prepatellar bursitis.
Overall, prepatellar bursitis caused by an injury will normally go away on its own. The body will absorb the blood in the bursa over several weeks. If swelling in the bursa is causing a slow recovery, a needle may be inserted to drain the blood and speed up the process. However, unfortunately, there is a slight risk of infection in putting a needle into the bursa.
Prepatellar bursitis can be a major problem. The swelling and tenderness cause pain and difficulty when kneeling. Treatment usually begins by trying to control the inflammation. This may include a short period of rest or possibly a brace to immobilize the knee. Medications such as ibuprofen and aspirin can be suggested by your doctor to control inflammation and swelling. A knee pad may also be helpful to ease the pain. If an infection is discovered, the bursa will need to be drained several times over the first few days. You will be placed on antibiotics for several days. If the infection is slow to heal, the bursa may have to be drained surgically.
Your doctor may also prescribe rehabilitation. Additionally, a physiotherapist may suggest the use of heat, ice, and ultrasound to help calm the pain and swelling. The therapist may also recommend specialized stretching and strengthening exercises used in combination with a knee brace, taping of the patella, or shoe inserts. These exercises and aids are used to improve muscle balance and joint alignment of the hip and lower limb, easing pressure and problems in the bursa. Regarding exercises that can help reduce any further development of prepatellar bursitis, here are some exercise methods for you to try:
Lie on your back with your affected knee straight. Your good knee should be bent. Afterwards, bend your affected knee by sliding your heel across the floor and toward your buttock until you feel a gentle stretch in your knee. Finally, hold this position for about 6 seconds, and then slowly straighten your knee. After finishing the first set, repeat 8-12 times a day.
Firstly, sit with your affected leg straight and supported on the floor or a firm bed. Secondly, place a small, rolled-up towel under your affected knee. Your other leg should be bent, with that foot flat on the floor. Tighten the thigh muscles of your affected leg by pressing the back of your knee down into the towel. Lastly, hold for about 6 seconds, then rest for up to 10 seconds before repeating the exercise 8-12 times a day.
Lie on your back with your good knee bent so that your foot rests flat on the floor. Your affected leg should be straight (make sure that your lower back has a normal curve). You should be able to slip your hand in between the floor and the small of your back, with your palm touching the floor and your back touching the back of your hand. Tighten the thigh muscles in your affected leg by pressing the back of your knee flat down to the floor. Hold your knee straight, then while keeping the thigh muscles tight and your leg straight, lift your affected leg up so that your heel is about 30 centimeters off the floor. Finally, hold for about 6 seconds, then lower slowly. Rest for up to 10 seconds between reps before repeating 8-12 times a day.
Alternative & Homeopathic Treatment
It is possible to successfully treat mild to moderate cases of prepatellar bursitis at home – home treatments for this condition include the following:
- Rest – Activities that may aggravate the affected prepatellar bursae, such as kneeling, crawling, or participating in high-impact sports, should be avoided. Rest can help reduce the symptoms at a higher rate as you are avoiding most activities simply by resting your affected knee.
- Cold compression – Applying a cold compress to the knee may help decrease swelling and alleviate other symptoms. A cold compress can be purchased or made at home and applied to the knee for about 20 minutes 2-3 times a day.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen, may reduce knee pain, swelling, and inflammation.