About Kneecap (Prepatellar) Bursitis

Prepatellar bursitis is inflammation of the bursa sac located in front of the kneecap (patella). A bursa is a fluid-filled sac that acts as a cushion between bones and soft tissues, reducing friction.

Common Symptoms

• Swelling and visible lump on the front of the kneecap
• Pain and tenderness over the kneecap, worsened by activity
• Warmth and redness around the kneecap
• Stiffness and reduced range of motion
• With infection: fever, chills, increased redness and warmth

Cause & Anatomy

• Repetitive kneeling or direct trauma/impact to the front of the knee can irritate the prepatellar bursa, causing inflammation.
• It is common in occupations or activities involving frequent kneeling like carpentry, plumbing, gardening, etc.
• Other risk factors include gout, rheumatoid arthritis, and bacterial infection (septic bursitis).

Diagnosis

• Based on physical examination, patient history, and location of swelling/tenderness
• X-rays may be done to rule out other conditions
• Aspiration of bursa fluid may be performed if infection is suspected

Prevention

Key points about preventing prepatellar (kneecap) bursitis:

Avoid Repetitive Kneeling

• Prepatellar bursitis is commonly caused by repetitive kneeling or direct trauma to the front of the knee.
• For occupations or activities that involve frequent kneeling (e.g. carpentry, plumbing, gardening), it is important to avoid prolonged kneeling whenever possible.

Use Knee Pads

• Wearing knee pads can help prevent irritation and trauma to the prepatellar bursa when kneeling is unavoidable.
• Knee pads provide cushioning and protection for the front of the knee.

Take Breaks and Stretch

• For activities involving prolonged kneeling, take regular breaks to stretch your legs and avoid excessive pressure on the knees.
• Varying activities can also help reduce repetitive stress on the knees.

Proper Footwear and Equipment

• Wear shoes with adequate cushioning and support to reduce stress on the knees during activities.
• Use proper sports techniques and protective equipment for activities with a risk of knee trauma or falls.

Apply Ice and Elevate After Activity

• After activities that strain the knees, apply ice packs to the front of the knees to reduce inflammation.
• Elevating the legs can also help minimize swelling and discomfort.

Treat Underlying Conditions

• Manage conditions like gout, rheumatoid arthritis or infections that increase the risk of bursitis.

Treatment

Nonsurgical treatments are usually effective for managing prepatellar bursitis when the bursa is simply inflamed and not infected. The recommended nonsurgical treatments include:

• Rest and activity modification to avoid aggravating the bursitis
• Ice application to reduce inflammation and pain
• Elevation of the affected leg
• Over-the-counter anti-inflammatory medications (NSAIDs) like ibuprofen
• Aspiration (draining) of excess fluid from the inflamed bursa with a needle
• Corticosteroid injection into the bursa after aspiration to reduce inflammation

The key is identifying and addressing the underlying cause, whether it is repetitive irritation, trauma, infection, or an inflammatory condition. Early treatment can prevent chronic, recurrent bursitis.

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