MANUAL MINORS
Prepatellar and infrapatellar bursitis is the inflammation of the bursae, small fluid-filled sacs that cushion and reduce friction between bones and soft tissues. In the knee, the prepatellar bursa is located just in front of the kneecap, and the infrapatellar bursa is situated below the kneecap near the patellar tendon. Bursitis often occurs due to repetitive trauma, prolonged pressure, or infections, and presents with localised swelling, tenderness, and pain.
Diagnosis
Diagnosis is based on clinical presentation, where visible swelling is observed over the kneecap (prepatellar) or just below the kneecap (infrapatellar). A history of trauma or repetitive activities, such as kneeling, is relevant.
In chronic cases or when infection is suspected, imaging studies such as ultrasound or magnetic resonance imaging (MRI) may be useful to confirm the diagnosis and rule out other injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Patellar Tendinitis | Pain more localised to the patellar tendon, without visible swelling |
Meniscal Injury | Deep knee pain, locking or clicking, without superficial swelling |
Patellar Tendon Rupture | Inability to extend the knee, elevated kneecap on X-ray |
Knee Osteoarthritis | Chronic pain, stiffness, and joint deformity without localised bursal inflammation |
Cellulitis | Generalised inflammation with signs of infection, erythema, and fever |
Emergency Management
In emergencies, initial management includes resting the affected knee, applying gentle compression, using ice to reduce inflammation, and elevating the limb.
Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) can be administered to control pain. If infection is suspected (septic bursitis), aspiration of the bursal fluid for microbiological analysis and the initiation of empirical antibiotics may be necessary.
Definitive Treatment
Definitive treatment depends on the cause of the bursitis. In non-infectious cases, physiotherapy, rest, and possibly corticosteroid injections into the bursa are recommended to reduce inflammation.
If the bursitis is septic, the bursa should be drained through aspiration or surgical drainage, and a full course of antibiotics should be administered. If there is a persistent mechanical cause (such as repeated pressure), activities should be modified to prevent recurrence.
Comments