Abstract
Knee pain is a very common complaint in routine physiatry and orthopedic practice. While bursitis is a well-known and common cause of knee pain, deep infrapatellar bursa (DIPB) involvement is relatively less common. Inflammation of DIPB occurs commonly due to either direct trauma or overuse, but other rare causes have also been reported in the literature including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We report a case of chronic inflammation of DIPB caused by direct trauma and associated with patellar tendinopathy. Additionally, we describe the characteristic findings on musculoskeletal ultrasonography (MSK-USG). For ultrasound evaluation, the patient should lie supine with the knee slightly flexed. Deep infrapatellar bursitis can be seen as an anechoic fluid-filled structure immediately posterior to the distal patellar tendon and anterior to the tibial tuberosity. While MRI can confirm the diagnosis of bursitis, MSK-USG can be quick, highly sensitive, and is able to confirm the diagnosis as well as to detect dynamic changes in the patellar tendon and adjacent structures. USG can also help in the treatment by guiding corticosteroid injection into the bursa. Activity modification and eccentric exercises play an important role in the rehabilitation program in these cases.
Highlights
Bursitis is defined as the inflammation of a bursa, which is a synovium-lined, fluid-filled, sac-like structure typically found around large joints such as the hip, knee, shoulder, and elbow
We report a case of chronic inflammation of deep infrapatellar bursa (DIPB) caused by direct trauma and associated with patellar tendinopathy
We present a case of chronic inflammation of DIPB of traumatic etiology complicated by the presence of patellar tendinopathy and its evaluation with musculoskeletal USG (MSK-USG)
Summary
Bursitis is defined as the inflammation of a bursa, which is a synovium-lined, fluid-filled, sac-like structure typically found around large joints such as the hip, knee, shoulder, and elbow. The patient was a housewife and she provided no history of any chronic medical illness, frequent kneeling, or jumping activities She had already consulted many physicians for the intermittent pain exacerbations and was able to manage the pain with painkillers only without the condition being diagnosed. The affected knee showed an anechoic fluidfilled area immediately posterior to the distal patellar tendon and anterior to the tibia, suggesting a distended DIPB. The patient was followed up for three months and complete resolution of symptoms was observed with occasional activity-related discomfort in the anterior knee attributable to tendinopathy. She was advised to continue with eccentric quadriceps strengthening exercises and activity modifications
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