Prepatellar Bursitis (Knee Bursitis)

Prepatellar bursitis is inflammation of the bursa (a fluid-filled sac) that’s located in front of your kneecap (patella). Knee bursitis happens when irritation, infection or damage affects the bursa and it makes too much fluid. The extra fluid causes the bursa to swell and puts pressure on other parts of your knee joint. You can usually see prepatellar bursitis because the front of your knee looks swollen.

Prepatellar bursitis is the second most common type of bursitis. Other names for the condition include:

• Housemaid’s knee
• Carpenter’s knee
• Coal miner’s knee
• Carpet layer’s knee

Types of prepatellar bursitis

There are two types of prepatellar bursitis:

• Acute prepatellar bursitis. This type happens when sudden (acute) damage affects the bursa. It usually occurs due to trauma (like a forceful impact to your knee) or a bacterial infection.
• Chronic prepatellar bursitis. Chronic bursitis of the knee usually happens from repeated overuse or pressure on your knee, like frequent kneeling.

Signs and symptoms of knee bursitis

Knee bursitis symptoms depend on the type you have and how severe it is. There are three general signs of prepatellar bursitis. But you don’t need to have all three to have the condition. The three signs are:

• Knee pain. Some people feel achiness or tenderness even while resting. Others experience no pain while resting but feel pain or tenderness in their affected knee when they kneel or bend it.
• Swelling at the front of your knee. You’ll be able to see and feel the swollen bursa sac through your skin. It usually feels squishy when you press on it.
• Range of motion limits in your knee. If you have a severe case of prepatellar bursitis, you may not be able to bend and stretch your knee like you usually do.

If an infection causes the knee bursitis, you’ll likely have additional symptoms, including:

• Red, pink or purple skin where your knee is swollen
• Warmer skin where your knee is swollen
• Fever
• Achiness and chills

If you’re experiencing symptoms of an infection, it’s important to contact your healthcare provider immediately or go to the nearest hospital. Infected prepatellar bursitis needs medical treatment. If left untreated, it can cause serious and life-threatening complications.

Bursitis of the knee causes

There are a few situations and conditions that can cause prepatellar bursitis, including:

• Frequent kneeling. Pressure and irritation from frequent kneeling cause most cases of prepatellar bursitis.
• A direct hit to the knee. Trauma to your knee from falling or getting hit with something can cause prepatellar bursitis.
• Bacterial infection. If you have a scratch, insect bite or cut on your knee that becomes infected, it can spread to your prepatellar bursa sac. This is called infectious bursitis.
• Rheumatoid arthritis and/or gout. Although it’s not as common, both rheumatoid arthritis and gout can cause prepatellar bursitis.

Risk factors for prepatellar bursitis

Anyone can get prepatellar bursitis, but it most commonly affects people:

• Between the ages of 40 and 60
• Who are male
• Who have jobs or hobbies that involve frequent kneeling, like carpentry and gardening
• Who play contact sports that can lead to harsh knee impacts, like football, wrestling or rugby
• Who have a health condition that weakens the immune system

Future complications for knee bursitis

If left untreated, prepatellar bursitis that involves an infection can lead to severe complications like septic shock or even death. It’s essential to contact your healthcare provider immediately or go to the nearest hospital if you’re experiencing symptoms of an infection.

How doctors diagnose prepatellar bursitis

Your healthcare provider will ask you questions about your symptoms and medical history. Then, they’ll do a physical exam, focusing on your affected knee. They’ll check for pain, tenderness and the range of motion of your knee. Imaging tests can also help confirm a knee bursitis diagnosis or rule out other possible conditions.

Tests that are used to diagnose prepatellar bursitis

Specific tests that providers can use to help diagnose prepatellar bursitis or rule out other possible conditions include:

• Knee X-rays. Your healthcare provider can use an X-ray to confirm whether or not you have a bone injury that’s causing your pain and swelling.
• CT scan or MRI. Your provider may request a CT scan or an MRI to check for an injury to the soft tissue in or around your knee that could cause swelling.
• Ultrasound. Your provider can use an ultrasound to determine whether you have an inflamed prepatellar bursa or another condition, like pes anserinus bursitis.
• Prepatellar bursa aspiration. If your provider thinks you may have an infection in your bursa sac, they’ll draw fluid from the sac with a fine needle (aspirate) to check for bacteria.

How is knee bursitis treated?

Prepatellar bursitis treatment depends on the severity of the condition. You can treat most cases of prepatellar bursitis that just involve inflammation from home without medical intervention. If an infection is the cause of the prepatellar bursitis, you’ll need antibiotics to treat it.

Treatment for prepatellar bursitis that involves just an inflamed bursa may include:

• Resting and minimizing certain activities. Be sure to avoid or minimize activities and motions that make your symptoms worse until your bursitis of the knee gets better.
• Applying ice. Applying ice to your knee at regular intervals can help reduce swelling and pain.
• Elevating your leg. Try to elevate your leg with the affected knee when you’re resting.
• Compressing your knee. Compression can help reduce swelling.
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs like ibuprofen and naproxen can help reduce pain and inflammation.
• Bursa injection. In some cases, your healthcare provider may give you a steroid injection to help with the inflammation if rest and anti-inflammatory drugs aren’t working.

Treatment for prepatellar bursitis that involves an infection may include:

• Antibiotics. You need antibiotics to treat a bacterial infection. Your healthcare provider may give you medication to take by mouth (orally) or through an IV (intravenously).
• Surgical drainage. If antibiotics aren’t treating the infection, your provider may need to surgically drain your prepatellar bursa.
• Bursectomy. If antibiotics and surgical drainage don’t treat the infection, your provider will need to surgically remove your bursa.

When should I see my healthcare provider?

If you’re experiencing a fever, chills and other signs of an infection, contact your healthcare provider right away or go to the nearest hospital. Prepatellar bursitis that involves an infection needs immediate medical treatment.

How can I prevent prepatellar bursitis?

There are a few things you can do to prevent prepatellar bursitis, including:

• Using knee pads. If you have a job that involves frequent kneeling or you play a contact sport, wearing knee pads can help cushion your knee and prevent too much pressure on your bursa.
• Avoiding infections. If you have a cut or insect bite on your knee, be sure to keep it clean to avoid getting an infection that could spread to your bursa.
• Applying ice and elevating your knees after exercising. Apply ice and elevate your legs after participating in activities or workouts that involve frequent kneeling or squatting.

What is the prognosis (outlook) for prepatellar bursitis?

You can treat most cases of prepatellar bursitis from home with rest, ice, compression and elevation. The swelling and other symptoms usually go away in a couple of weeks, and you shouldn’t have any lasting side effects. If the prepatellar bursitis doesn’t get better after two to three weeks of rest, reach out to your healthcare provider.

Chronic knee bursitis may be more difficult to treat, especially if you have a job that requires frequent kneeling. Your healthcare team will come up with a treatment plan that works best for you and your situation. If left untreated, chronic prepatellar bursitis can last months or even years.