Cite This Article

Segel, N. Tomesch, A. Behind the Knee Pain. Ortho Pearls. July 10, 2024; Available: https://www.orthoempearls.com/articles/behind-the-knee-pain

What is the diagnosis?

Prepatellar Bursitis  

• Pearl: Prepatellar bursitis is the inflammation of the bursa in front of the patella. The bursa is a fluid filled area between the skin and underlying tendons/bones which help in decreasing friction. The pre patellar bursa is an often affected bursa due to the impact of repetitive kneeling [1]. 

• Pearl: There are over 150 known bursae in the human body. They help facilitate movement in the musculoskeletal system, creating a cushion between tissues that move against one another [2]

What is the mechanism of injury?

The mechanism of injury is often due to repetitive kneeling. It can also be caused by acute trauma. Less commonly, it may also arise from underlying factors such as gout, rheumatoid arthritis or infections [1].

What physical exam findings are expected?

Acute bursitis often presents with erythema, warmth, tenderness and decreased range of motion on flexion and extension due to discomfort. Chronic bursitis is often painless, and physical exam will show an increased area of swelling in the area of bursae [1].

Which imaging modalities can be used?

Plain film radiographs can be used to evaluate for any acute fracture/dislocation. Ultrasound may also be used to evaluate the bursae as well as look for overlying cellulitis[2].

What is the management in the ED?

The treatment of prepatellar bursitis focuses on alleviating inflammation, reducing pain, and preventing further irritation of the bursa. Initial management includes rest and avoiding activities that exacerbate the condition, such as prolonged kneeling. Applying ice packs intermittently can help reduce swelling, while compression with an elastic bandage and elevating the affected knee can further alleviate symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to manage pain and inflammation [1, 2]If there is concern for septic bursitis, one may consider aspiration for fluid analysis [1].

When do you consult Orthopedics?

Initial cases of bursitis rarely require orthopedic consultation. If there is concern for septic bursitis, then an orthopedic consult might be necessary [1].