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Introduction

Knee Pain

Knee Bursitis
- Prepatellar Bursitis (Housemaid's Knee)

Prepatellar bursitis is also called housemaid's knee or carpenter's knee. A bursa is a fluid-filled sac which ensures there is less friction between body parts. The prepatellar bursa is located superficially between the skin and the patella. The inflammation of a bursa is called bursitis. This inflammation can take form by either an infectious nature (30%) or a non-infectious nature (70%).

A direct fall on the patella, an acute trauma, repeated blows or friction on the knee may cause prepatellar bursitis. Other causes include infections or low-grade inflammatory conditions, such as gout, syphilis, tuberculosis or rheumatoid arthritis. Prepatellar bursitis often occurs in specific jobs which involve a position where they work on their knees for a prolonged period of time such as miners, gardeners, carpet layers and mechanics.

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Causes

A sudden, one-off injury to the knee: This might be, for example, a fall or direct blow on to the knee.

 

Recurrent minor injury to the knee: This usually happens after spending long periods of time kneeling down, putting pressure on the kneecap (patella). Historically, this was typical of housemaids who spent long periods of time on their knees scrubbing floors; hence, the term housemaid's knee.

 

Infection: The fluid in the prepatellar bursa sac can become infected and cause inflammation within a bursa (bursitis). This is known as septic bursitis. It is particularly common in children with housemaid's knee. This usually follows a cut, scratch or injury to the skin on the surface of the knee which allows germs (bacteria) to spread infection into the bursa.

 

Another inflammatory disease: If you already have an inflammatory disease such as rheumatoid arthritis, you have an increased risk of developing a bursitis. Rheumatoid arthritis is a form of arthritis that causes inflammation, pain and swelling of joints.

 

Gout: If you have gout or pseudogout you have an increased risk of developing a bursitis. Gout is caused by a build-up of uric acid crystals. Uric acid is a chemical in the blood that is usually harmless and passed out with the urine. In gout, it builds up and collects within a joint, causing pain, inflammation and joint swelling.

Symptoms
  • Pain and swelling of the affected area.

  • Redness of the skin over the knee.

  • A tender kneecap.

  • Difficulty bending the knee and difficulty kneeling and walking.

  • If housemaid's knee is caused by infection, you may have a high temperature (fever).

Diagnosis

During the physical examination, your doctor will inspect your affected knee and compare it to your healthy knee. They will examine your knee, checking for tenderness, and will also assess the range of motion in your knee and whether pain prevents you from bending it.

 

Your doctor may employ the following tests:

  • X-rays. Your doctor may order X-rays to make sure there is not a fracture or other bony problem that is causing your symptoms.

  • Other imaging tests. The diagnosis of bursitis is usually made on physical examination, but computerized tomography (CT) and magnetic resonance imaging (MRI) scans may be ordered to check for other soft tissue injury.

  • Aspiration. If your doctor is concerned about the possibility of infection, they may aspirate (draw fluid with a needle) from the bursa and send this sample to the lab for analysis.

Non-surgical treatments

Nonsurgical treatment is usually effective as long as the bursa is simply inflamed and not infected:

  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Aspiration & cortisone injection: If the swelling and pain do not respond to the above measures, your doctor may drain (aspirate) the bursa with a needle, then inject the bursa with a corticosteroid (cortisone injection). The corticosteroid is an anti-inflammatory drug that is stronger than medications that can be taken by mouth.

  • Antibiotics: Infectious bursitis is initially treated with antibiotics. 

  • Surgical drainage: This is required if infectious bursitis does not respond to antibiotics alone.

Surgery