Prepatellar bursitis (housemaid’s knee): Treatment, symptoms, advice & help

About prepatellar bursitis (housemaid’s knee)

Prepatellar bursitis is characterised by inflammation of the bursa (fluid-filled sac located especially at large joint spaces), which is located between the patella (knee cap) and the skin. The pre-patellar bursa is responsible for reducing friction and increasing the range of motion at the knee joint. This bursa can get inflamed by several underlying causes, of which prolonged kneeling position is the commonest. Therefore this condition is also known as ‘housemaid’s knee.

Prepatellar bursitis (housemaid’s knee): Incidence, age and sex

Although, prepatellar bursitis is called ‘housemaid’s knee’, its incidence is higher in men as compared to women. It may occur in any age group; however middle-aged and older adults seem to be more frequently afflicted.

Signs and symptoms of prepatellar bursitis (housemaid’s knee): Diagnosis

Prepatellar bursitis is characterised by persistent pain and stiffness of the knee joint. The pain may get exacerbated on kneeling on the affected side. Sometimes, the movement of the affected knee may be greatly hampered. Other features include swelling and redness of skin overlying the knee cap may also be observed. A detailed history may reveal prolonged stress on the knee joint due to longstanding kneeling or a history of fall on the knee or even blunt trauma to the knee.

Generally, a detailed medical history coupled with physical examination is enough to diagnose the condition. No investigations are required to establish the diagnosis. However, if the bursa is suspected to be infected, then it is advisable to aspirate the fluid from bursa to get it investigated and cultured for the identification of various entities like bacteria, crystals, glucose and white blood cell count and so on.

Causes and prevention of prepatellar bursitis (housemaid’s knee)

Prepatellar bursitis may occur in response to increase wear and tear or excessive repetitive movement (like kneeling) of the knee joint. This leads to increased friction of the bursa which predisposes to its inflammation. Other causes like repeated small injuries or a direct blow to the knee joint may also lead to this condition. Inflammatory diseases like arthritis and gout may also cause bursitis. Bacterial infections of the joint have also been documented to result in bursitis; although rare, such incidences are seen in immuno-compromised children. Infectious bursitis is termed as ‘septic bursitis’, and a non-infectious bursitis as ‘non-septic bursitis’.

Prepatellar bursitis (housemaid’s knee): Complications

In most of the incidences, prepatellar bursitis is a self-limiting disorder which does not result in any noticeable complications other than limitation of movement of the concerned knee joint.

Prepatellar bursitis (housemaid’s knee): Treatment

The treatment of prepatellar bursitis includes cold compress and analgesics which may help in minimising pain and swelling. Elevation of the affected knee may also help in reducing swelling. It is advisable to immobilise the joint with a sling or a splint to provide adequate rest to the joint. Medications like steroids may be injected into the bursa in occasional individuals to minimise pain and swelling. This is a self-limiting condition and usually resolves within a few weeks. However, it is essential to evaluate the underlying cause of prepatellar bursitis and manage it to prevent further recurrence. Individuals with septic arthritis may need more comprehensive management including paracetamol for fever or long-term intravenous antibiotic therapy to control the infection. Sometimes, incision and drainage of the bursitis may also be needed in resistant cases. Physiotherapy or knee pads are recommended for prevention of recurrence of such incidences.