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Introduction

Knee Pain

Knee Bursitis
- Infrapatellar Bursitis

Infrapatellar bursitis is inflammation of the superficial or deep infrapatellar bursa. Symptoms may include knee pain, swelling, and redness just below the kneecap. It may be complicated by patellar tendonitis.

Risk factors include kneeling or crawling. It may also be brought on by frequent bending of the knees while standing, squatting, running, or jumping. Diagnosis is generally based on symptom and physical examination. When the deep bursa is involved, bending the knee generally increases the pain. Other conditions that may appear similar include patellar tendonitis and prepatellar bursitis.

Treatment is generally by rest, alternating between ice and heat, and NSAIDs. Infrapatellar bursitis is relatively rare. It has also been called vicar's knee and clergyman's knee.

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Causes

Common causes of infrapatellar bursitis include:

  • Frequent Kneeling or Crawling: when you are on your knees, excess pressure goes through the infrapatellar bursa, squashing it. This causes the bursa to gradually thicken and swell  

  • Overuse: Activities that require frequent bending of the knee, such as running, jumping kicking, climbing or stairs, places a lot of friction on the bursa causing it to swell 

  • Injury: A sudden, hard blow to the front of the knee can damage the infrapatellar bursa directly, or cause bleeding and excess fluid around the knee which seeps into the infrapatellar bursa, causing it to swell 

  • Knee Conditions: Infrapatellar bursitis often develops secondary to other knee problems, most commonly jumpers knee (patellar tendonitis) and Osgood Schlatters Disease 

  • Infection: Septic bursitis develops when bacteria enter the infrapatellar bursa through a cut in the skin, causing an infection

Symptoms

Infrapatellar bursitis symptoms usually come on gradually over a few weeks or months and consist of:

  • Swelling: There is often swelling at the front of the knee with infrapatellar bursitis. There may be a squashy pocket of fluid at the front of the shin, just below the kneecap which is tender to touch 

  • Knee Pain: Pain from infrapatellar bursitis is usually felt at the front of the knee, just below the kneecap, causing pain just below the knee. It may extend down the front of the shin too. Infrapatellar bursitis pain typically gets worse when bending the knee and climbing stairs. Kneeling will be very painful as it squashes the bursa 

  • Redness & Warmth: There may be an area of redness at the front of the knee, particularly with septic infrapatellar bursitis, and the skin may feel warm to touch 

  • Difficulty Sleeping: Sleep is often affected with bursitis with frequent waking due to pain surges when bending the knee or rolling over as you sleep 

  • Knee Stiffness & Weakness: The pain from clergyman’s knee may cause you to use the knee less which in time can lead to stiffness and weakness in the joint

Diagnosis

To diagnose infrapatellar bursitis your doctor will start by asking you about your symptoms, such as how the pain started and what aggravates it. They will then examine your knee and perform various tests to look at the integrity of the different knee structures.

They may send you for an x-ray to rule out an underlying bone spur or bony injury. If they suspect soft tissue damage then they will send you for an MRI scan.  

If they suspect septic bursitis, your doctor will remove some fluid from the bursa with a needle and have it tested for infection.

Non-surgical treatments

There are a number of treatment options for infrapatellar bursitis:

  • Rest: Avoid activities and exercises that aggravate your knee. The bursa needs time to heal. If you don’t rest, the infrapatellar bursa will keep getting irritated and inflamed and will take longer to heal 

  • Keep Pressure Off: Keep as much pressure off your knee as possible – try to avoid kneeling or crawling altogether. If you have to kneel, either wear knee pads or kneel on a cushion. And it can really help to make some simple changes to how you go up and down stairs, particularly if that is something which hurts  

  • Ice: Regularly applying ice to the front of the knee can help reduce the pain and inflammation from infrapatellar bursitis, but it is important to follow the recommended guidelines – visit the knee ice treatment section to find out more 

  • Medication: Your doctor may advise taking non-steroidal anti-inflammatories (NSAID’s) to help reduce pain and swelling with bursitis 

  • Aspiration: Your doctor can remove excess fluid from the infrapatellar bursa using a needle and syringe. They may inject corticosteroids into the bursa at the same time to further reduce pain and swelling 

  • Physical Therapy: Strengthening exercises and stretches are an important part of rehab with infrapatellar bursitis to regain full strength, mobility and function in the knee

Surgery