Prepatellar bursitis and other knee bursitis

Prepatellar bursitis is a disease of the musculoskeletal system caused by inflammation of the prepatellar sac. The disease is manifested by swelling of the anterior surface of the knee joint-above the patella, pain when extending and flexing in the knee joint, when resting on the knee joint.


  
CAUSES OF PREPATELLAR BURSITIS

The causes of inflammation can be different: from a banal injury to infection. According to the classification, septic (infectious) and aseptic (inflammatory) bursitis are distinguished. Both types of bursitis are characteristic of the prepatellar sac.
In some cases, the prepatellar bag may be damaged as a result of a direct mechanism of injury, such as a blow or a fall on the knee. The injury causes tears in the tissues of the prepatellar sac and hemorrhage in the sac cavity. In some cases, the blood can completely fill the cavity of the prepatellar bursa and the bursa can swell, causing the knee joint to take a characteristic shape. 
It is believed that the blood accumulated in the cavity of the prepatellar bag triggers an inflammatory reaction. As a result of inflammation, the walls of the prepatellar sac thicken, become less elastic, and their sliding properties disappear. As a result, prepatellar bursitis develops.

Prepatellar bursitis can occur due to constant pressure on the patella. Some workers perform work in a position where they rest their knees on a hard surface. If the knee is constantly injured , this leads to the development of inflammation and prepatellar bursitis develops. 

Prepatellar bursitis can be caused by an infection. A small scratch or prick in the area of the prepatellar sac can lead to infection. Or, after an injury, the infection can enter the damaged tissues of the prepatellar sac with blood flow from the focus of a chronic infection in the body, for example, a carious tooth. The infection leads to the accumulation of pus in the cavity of the prepatellar sac. The consequences of infectious prepatellar bursitis can be quite serious.

SYMPTOMS OF PREPATELLAR BURSITIS

Prepatellar bursitis is manifested by pain and swelling above the patella. When examined during palpation (groping), the prepatellar sac is usually painful. In this condition, it is painful to stand with your knee on a hard surface. If prepatellar bursitis does not go away for a long time, then the inflammation becomes chronic. There may be a feeling that there are lumps in the inflammatory fluid in the prepatellar bag. This suggests that the prepatellar sac in response to chronic inflammation has become even thicker and folds have formed. These folds feel like lumps.

The prepatellar bag can increase in size several times. This is due to the thickening of the walls of the prepatellar sac and the filling of the prepatellar sac with inflammatory fluid. The amount of inflammatory fluid is usually associated with the phase of inflammation. If the inflammation is in the active phase, the amount of inflammatory fluid increases, and the bag increases in size. With large sizes of the prepatellar bag, the knee joint, when viewed from the side, takes on a characteristic appearance.

If there is an infection of the prepatellar sac, the knee becomes swollen, very painful and warm to the touch. In this case, in addition to local signs of inflammation (pain, redness, increased local temperature, edema), general symptoms develop – fever, chills, changes in the blood test. Emergency surgical intervention is required – opening and draining of the prepatellar bag. If you do not consult a doctor and do not perform an autopsy of the prepatellar bag, the pus can break through on its own, and systemic complications may occur.

DIAGNOSIS OF PREPATELLAR BURSITIS

Differential diagnosis of bursitis of the prepatellar sac is carried out with such diseases as gout, rheumatoid arthritis, septic arthritis of the knee joint.

The diagnosis of bursitis of the prepatellar sac becomes obvious after examining the patient, no special examination methods are required. If you still need a follow-up examination, then ultrasound allows you to quickly and confidently confirm the diagnosis of prepatellar bursitis.

If it is not clear to the doctor whether the bursitis is inflammatory or infectious, then a puncture of the prepatellar bag is performed and the resulting fluid sample is sent to the laboratory for examination. Liquid cultures are performed to detect microflora and determine its sensitivity to antibacterial drugs. Thus, the doctor gets an answer to two questions: whether bursitis is infectious or inflammatory, and, if bursitis is infectious, what kind of antibiotic it should be treated with.

TREATMENT OF PREPATELLAR BURSITIS

Conservative treatment

Traumatic bursitis of the prepatellar sac can be treated conservatively. If a significant amount of blood has accumulated as a result of the injury, then a puncture with a thick needle is performed or a small incision is made to remove all the accumulated blood from the cavity of the prepatellar bag. The question of whether a puncture is appropriate is decided by the doctor.

There is a small risk of infection of the prepatellar bag during these manipulations, so the puncture is performed in the dressing room in compliance with all the rules of asepsis and antiseptics. After performing the puncture, a sterile dressing is applied.

Chronic bursitis of the prepatellar sac is a problem that can reduce the ability to work and worsen the quality of life. Edema and pain are the main manifestations. Ordinary everyday activities can cause discomfort. Treatment usually begins with an attempt to relieve the inflammatory syndrome. Measures to relieve inflammation are rest in the knee joint and the use of anti-inflammatory drugs. Medications such as diclofenac and ibuprofen are used to relieve inflammation and swelling.

If there is inflammatory fluid in the bag, a puncture may be performed to remove the fluid and further test it in the laboratory. During the puncture ( provided that there are no signs of infection in the cavity of the prepatellar bag and there are no other contraindications), a small amount of a steroid agent, such as betamethasone salts, may be administered. Steroid medications are strong anti-inflammatory agents. Its anti-inflammatory effect can last for several weeks.

You need to consult with a physiotherapist who will help you choose physiotherapy procedures, taking into account all the features and contraindications.

Using heat, cold, ultrasound, or UHF usually helps reduce pain and swelling. The use of cold or heat treatments will help to improve the condition at home. Cold is usually indicated immediately after an injury, heat treatment - during chronic inflammation; in any case, the use of any methods of exposure should be discussed with your doctor.

If the bursitis is infectious, then the ulnar sac should be completely drained, that is, all inflammatory fluid or pus should be removed. A prerequisite is to ensure the rest of the knee joint and the appointment of antibacterial drugs. Patients with infectious bursitis are monitored by a doctor until the inflammation completely disappears.
                                              
Surgical treatment

Drainage of the prepatellar sac.
If an acute infection develops, or as a result of the study of the liquid obtained from the prepatellar bag, microorganisms were seeded, then it is necessary to drain the prepatellar bag. The prepatellar bag is opened surgically, that is, a small incision is made through which the discharge can be completely drained. Sometimes it is advisable to use a tube or half-tube to improve the outflow. After the outflow of the discharge is provided, the patient is observed until the wound is completely healed. Usually, the improvement occurs within a few days. In infectious bursitis, antibacterial drugs are necessarily prescribed.

Removal of the bursa (bursectomy).
In chronic bursitis, the walls of the bag thicken, the bag increases in size, and the folds of the bag appear. With conservative treatment, it is possible to remove the inflammation, but after some time, the inflammatory process again worsens. It becomes difficult to perform work and everyday activities. In this case, it is worth considering surgical treatment – removal of the prepatellar bag.
An incision is made in the projection of the prepatellar bag. The bag is excised. Determining the boundaries of the bag usually does not cause difficulties, since its walls are significantly thickened. After that, the wound is sewn up in layers. After the operation, it is advisable to place the leg in a splint for a few days to ensure rest and better healing of the postoperative wound, after which you can start rehabilitation activities.

Since in this area it is necessary to ensure that the skin slides over the patella, a new bag of connective tissue is formed in the body. This happens during the rehabilitation process some time after the operation. In order for this process to pass without complications, it is advisable to go through the prescribed rehabilitation program.

REHABILITATION AFTER TREATMENT OF PREPATELLAR BURSITIS