Prepatellar Bursitis

Overview

What is prepatellar bursitis?

Prepatellar bursitis (also called housemaid’s knee, carpet layer’s knee, coal miner’s knee or carpenter’s knee) is inflammation of the bursa (a fluid-filled sac) that is in front of your kneecap (patella). Prepatellar bursitis happens when your bursa is frequently irritated, damaged or infected and makes too much fluid. The extra fluid causes your bursa to swell and puts pressure on other parts of your knee. You can usually “see” prepatellar bursitis because the front of your knee will look swollen.

What is a bursa?

An adult person has more than 150 bursae (plural for “bursa”) throughout their body. A bursa is a small, fluid-filled sac that cushions an area where your bone would otherwise rub on your muscle, tendons or skin. By padding these areas, bursae help prevent friction and inflammation.

When your bursa sac is repeatedly irritated, damaged or infected, its thin lining thickens and makes extra fluid. The extra fluid collects in your bursa sac and causes it to swell. This is called bursitis. Bursitis most often happens to bursae around joints. Prepatellar bursitis is the second most common type of bursitis.

Are there different kinds of prepatellar bursitis?

There are two types of the condition: Acute prepatellar bursitis and chronic prepatellar bursitis. Acute prepatellar bursitis happens when there’s sudden damage to your bursa in front of your kneecap. This usually happens from trauma (such as a forceful impact to your knee) or an infection. Chronic bursitis usually happens from repeated overuse or pressure to your knee, such as frequent kneeling.

Who does prepatellar bursitis affect?

Anyone can get prepatellar bursitis, but it more commonly affects men between the ages of 40 and 60. Chronic prepatellar bursitis most commonly affects people who have jobs or hobbies that involve frequent kneeling, such as carpentry, house cleaning, plumbing and gardening. Children are more likely to develop septic prepatellar bursitis (an infection of the prepatellar bursa).

How common is prepatellar bursitis?

Prepatellar bursitis is fairly common. There isn’t an exact number of cases per year because many people have mild prepatellar bursitis and don’t need to seek treatment from a healthcare professional. Prepatellar bursitis is the second most common form of bursitis and is a common cause of knee swelling and inflammation.

Symptoms and Causes

What causes prepatellar bursitis?

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

  • Frequent kneeling: Most cases of prepatellar bursitis are caused by pressure and irritation from frequent kneeling.
  • 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 kind of prepatellar bursitis is called infectious bursitis. It’s not as common, but it’s a serious condition that needs immediate medical treatment.
  • Having rheumatoid arthritis and/or gout: Although it’s not as common, both rheumatoid arthritis and gout can cause prepatellar bursitis.

What are the signs and symptoms of prepatellar bursitis?

The symptoms of prepatellar bursitis depend on what type and how severe the bursitis is. There are three general signs of prepatellar bursitis, but you don’t have to have all three signs to have prepatellar bursitis. The three signs include:

  • Swelling at the front of your knee: Nearly all cases of prepatellar bursitis involve swelling at the front of your knee. You’ll be able to “see” and feel your swollen bursa sac through your skin. It usually feels “squishy” when you press on it. If your prepatellar bursitis isn’t treated, the swelling can increase.
  • Range of motion limits in your knee: Mild and moderate cases of prepatellar bursitis usually don’t limit your ability to bend and stretch your knee. If you have a severe case of prepatellar bursitis, you may not be able to move your knee like you usually do.
  • Pain: Some people don’t experience pain with prepatellar bursitis. Others may feel achiness or tenderness in their affected knee even while resting. Sometimes, people with prepatellar bursitis experience no pain while resting but feel pain or tenderness in their affected knee when they kneel or bend it.

If you have prepatellar bursitis that is caused by an infection, you’ll likely have additional symptoms, including:

  • Having reddish or pinkish skin where your knee is swollen.
  • Having warmer skin where your knee is swollen.
  • Having a fever.
  • Experiencing achiness and chills.

If you’re experiencing these symptoms of 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.

Diagnosis and Tests

How is prepatellar bursitis diagnosed?

Your healthcare provider can usually diagnose prepatellar from a physical exam. Your healthcare provider will ask you questions about your symptoms and history. They’ll then perform a physical exam to check for pain and tenderness and the range of motion of your affected knee. Imaging tests can also help confirm a prepatellar bursitis diagnosis or rule out other possible conditions.

What tests are used to diagnose prepatellar bursitis?

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

  • X-ray: Your healthcare provider may have you undergo an X-ray of your knee to make sure you don’t have a bone injury that’s causing your pain and swelling.
  • CT scan or MRI: Your healthcare provider may have you undergo a CT scan or MRI to check for an injury to the soft tissue in or around your knee that could be causing the swelling.
  • Prepatellar bursa aspiration: If your healthcare provider thinks you might have an infection in your bursa sac, they may draw fluid from your bursa sac with a fine needle (aspirate) to check the liquid for infection.

Management and Treatment

How is prepatellar bursitis treated?

The treatment for prepatellar bursitis depends on if your bursa is inflamed or infected. Most cases of prepatellar bursitis that just involve inflammation can be treated from home without medical intervention. If an infection is the cause of the prepatellar bursitis, antibiotics are needed to treat it.

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

  • Resting and minimizing certain activities: Be sure to avoid or minimize activities and motions that make your symptoms worse until your prepatellar bursitis 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.
  • Taking anti-inflammatory drugs: Anti-inflammatory drugs such as ibuprofen and naproxen can help reduce pain and inflammation.
  • Corticosteroid injection: In some cases, your healthcare provider may give you a corticosteroid injection to help with the inflammation if rest and other anti-inflammatory drugs aren’t working.

Treatment for prepatellar bursitis that involves an infection can include the following:

  • Antibiotics: Antibiotics are needed to treat bacterial infections. Your healthcare provider may have you take them by mouth as pills or by an IV.
  • Surgical drainage: If antibiotics aren’t working to treat the infection, you may need to have your prepatellar bursa surgically drained.

Prevention

What are the risk factors for developing prepatellar bursitis?

The following things are considered risk factors for developing prepatellar bursitis:

  • Frequent kneeling: Kneeling causes pressure to your knee and prepatellar bursa. People who kneel frequently, especially for their job, are more likely to develop prepatellar bursitis.
  • Having rheumatoid arthritis and/or gout: If you have rheumatoid arthritis and/or gout, you’re more likely to develop prepatellar bursitis.
  • Playing contact sports: Certain sports such as football, wrestling, rugby and basketball can lead to harsh knee impacts that can cause prepatellar bursitis.
  • Having an immunosuppressive condition: Conditions that weaken your immune system, such as diabetes, put you at a higher risk for developing an infection that can cause prepatellar bursitis.

How can I prevent prepatellar bursitis?

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

  • Use knee pads: If you have a job that involves frequent kneeling or play a contact sport, wearing kneepads can help cushion your knee and prevent too much pressure on your bursa.
  • Avoid 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.
  • Apply ice and elevate your knees after exercising: If you participated in an activity or workout that involved frequent kneeling or squatting, apply ice to your knees and elevate your legs afterward.

Outlook / Prognosis

What is the prognosis (outlook) for prepatellar bursitis?

Most cases of prepatellar bursitis can be treated from home with rest, ice and elevation, and don’t have any lasting side effects. Chronic prepatellar 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, prepatellar bursitis that involves an infection can lead to severe complications such as septic shock and 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 long does prepatellar bursitis last?

With rest and treating your prepatellar bursitis from home, the swelling and other symptoms usually go away in a couple of weeks. If your prepatellar bursitis doesn’t get better after two or three weeks of rest, reach out to your healthcare provider. You may need medical treatment.

Prepatellar bursitis that doesn’t go away or comes and goes frequently is called chronic prepatellar bursitis. If left untreated, chronic prepatellar bursitis can last months or even years.

Living With

When should I see my healthcare provider?

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

If you’ve been treating your prepatellar bursitis that is just inflamed (not infected) at home and it hasn’t gotten better after two or three weeks, contact your healthcare provider. You may need medical treatment.

A note from Cleveland Clinic

Prepatellar bursitis is a common condition that can usually be treated from home with rest. If your prepatellar bursitis is affecting your day-to-day life or doesn’t get better after a couple of weeks, reach out to your healthcare provider. If you’re experiencing symptoms of an infection, such as a fever or redness and warmth on the affected area, be sure to seek medical care as soon as possible.

Last reviewed by a Cleveland Clinic medical professional on 12/07/2021.

References

  • OrthoInfo. Prepatellar (kneecap) bursitis. (https://orthoinfo.aaos.org/en/diseases--conditions/prepatellar-kneecap-bursitis) Accessed 12/7/2021.
  • Rishor-Olney CR, Pozun A. Prepatellar bursitis. (https://www.ncbi.nlm.nih.gov/books/NBK557508/) [Updated 2/22/2021]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Accessed 12/7/2021.

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