Prepatellar Bursitis Research Articles

Knee Injury- Rare Presentation

HISTORY: 69 y/o Caucasian Male who runs for fitness, presented to Sports Medicine Clinic with 2 days of severe R Knee pain, swelling, limping and inability to extend his leg. No significant PMH. Reported no trauma or change in running habits. No previous corticosteroid injection. Recalled recently lifting a heavy sofa and going up and down stairs while cleaning his attic over the past weekend. No bruising or distal numbness, weakness or tingling. Minimal relief with Acetaminophen and Ice. PHYSICAL EXAMINATION: Examination revealed suprapatellar edema, tender over quadriceps tendon above patella. Unable to squat. Full active extension. Strength 5/5 on resisted straight leg raise. No ecchymosis. Remainder of knee exam unremarkable. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of Patella, Patellar Dislocation, Patellar Fracture, Patellar Tendon Rupture, Patello-Femoral Syndrome, Pre-Patellar Bursitis, Quadriceps Contusion, Quadriceps Strain, Quadriceps Tendinitis/Tendinosis. TEST AND RESULTS: 4 Radiographic Views of the Knee. Lateral View: oblique fractured calcification within the substance of the Quadriceps tendon. FINAL WORKING DIAGNOSIS: Fracture of Calcific Tendinosis within Quadriceps Tendon TREATMENT AND OUTCOMES: Immobilization with Post-Op Knee Brace in 5 degrees of Flexion. Ice. NSAID. Gentle range of motion exercises. Advance range of motion gradually. Progress to Physical Therapy for Quadriceps flexibility/strengthening with emphasis on eccentric contraction. Repeat Films at 3 and 6 weeks.

Clinical Case Knee Injury - Football

HISTORY: A 19 year old male lacrosse and football athlete presented with a one year history of right knee pain. The pain started after playing pick-up basketball. He was running for general exercise the next day, when he came to an abrupt stop associated with severe pain, and he fell to the floor. Pain was located over the inferior aspect of the right patella and proximal patellar tendon. He denied any numbness, paresthesias, or weakness in the right lower extremity, or swelling of the right knee joint. He was treated with PTO brace and physical therpay without significant improvement. PHYSICAL EXAMINATION: On inspection, he has mild pes planus, the right patella is internally rotated. Full PROM, with anterior knne pain on full flexion. With single leg squat, he had valgum movement of the knees bilaterally. He was tender to palpation over the inferior pole of the patella and proximal patellar tendon. He was not tender to palpation over the quad tendon, medial/lateral joint lines, medial/lateral patellar borders, or tibial tuberosity. There was no laxity noted with valgus or varus stress testing. Mcmurray, Lachman, Anterior and Posterior Drawer tests negative. Muscle strength was full. Sensation intact through all dermatomes. Muscle stretch Reflexes symmetric in the patella and Achilles. DIFFERENTIAL DIAGNOSIS: 1.Patellar Tendinosis 2.Patellar tendon rupture 3.Chondromalacia patella/Patellofemoral pain 4.Prepatellar Bursitis TEST AND RESULTS: Ultrasound Exam: large partial intrasubstance tear of medial aspect of the proximal patellar tendon MRI Right Knee: Partial tear/tendonitis of the proximal patellar tendon with associated thickening and edema. On the axial images, the tear is almost full thickness centrally. There is mild edema within the inferior pole of the patella. FINAL WORKING DIAGNOSIS: Partial Tear Right Patellar Tendon. TREATMENT AND OUTCOMES: •Platelet Rich Plasma injection using ultrasound guidance to the right patellar tendon •Rest × 2 weeks, followed by gradual increase in activity. •Patient reported 90% improvement at 5 weeks, tolerating running, swimming, and squats pain free.

Outsidein - David Newnham puts his finger on yet another ailment.

If the reader who once joked that 'Mr Newnham seems to have suffered every minor ailment in the book except housemaid's knee and gout' is still out there, then I have something to report. You can tick off gout.

Chemical Ablation as an Alternative to Surgery for Treatment of Persistent Prepatellar Bursitis

To the Editor: Swelling of the prepatellar bursa following trauma usually resolves with rest and protection. Aspiration is indicated to rule out infection and may need to be repeated, even when the fluid is not infected, when recurrent swelling is painful or restricts motion1. Injection of corticosteroids can be curative. Symptomatic bursitis that persists despite these measures is considered an indication for surgical removal of the bursa2. Methods to ablate the bursa by injections of other materials were described 25 or more years ago3,4, but have not been adopted into current practice. I successfully treated 2 patients with intrabursal injection of the sclerosing agent sodium morruhate, a method described more than 70 years ago3. I propose that this simple technique is worthy of wider application in treatment of persistent sterile prepatellar bursitis for which other conservative measures have failed and surgery … Address correspondence to Dr. R.W. Ike, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0358. E-mail: rike{at}umich.edu

Prepatellar Septic Bursitis: A Case Report of Skin Necrosis Associated With Open Bursectomy

Patients with prepatellar septic bursitis are typically successfully managed nonoperatively with rest, compression, immobilization, aspiration, and antibiotics. Rarely, surgical excision of the bursa may be required for recalcitrant cases. Prepatellar bursectomy, however, has been associated with considerable risk of surgical-site morbidity. Although skin necrosis is frequently cited as a complication of open bursectomy, there is limited information in the medical literature on the etiology and management of this rare but serious complication.

Unilateral Knee And Thigh Pain - Football

HISTORY: A 19-year-old college football defensive end presented to the team physician 2 weeks after being "clipped" on the left knee by another player's helmet during a game. He continued to play and completed the game. There was a gradual onset of moderate swelling and pain in the knee and thigh that same day. In the 2 weeks following the injury he had persistent "tiredness", lack of strength, and cramping pain in his left thigh during practice. He was asymptomatic during normal ambulation. PHYSICAL EXAMINATION: Examination in the training room revealed tenderness over the lateral aspect of the proximal patellar pole with an associated palpable 2-3 cm defect in the quadriceps tendon. There was full active range of motion of his knee. Knee extension against resistance was painful and revealed 4/5 strength. The remainder of his thigh and knee exam was normal. DIFFERENTIAL DIAGNOSIS: Quadriceps tendon rupture Quadriceps tendon avulsion injury Vastus lateralis muscle tear TEST AND RESULTS: Knee MRI: Estimated 25-30% rupture of the lateral most aspect of quadriceps tendon complex. Prepatellar bursitis. No associated fracture, meniscal, ligamentous, muscular pathology. FINAL WORKING DIAGNOSIS: Partial quadriceps tendon rupture TREATMENT AND OUTCOMES: 1. Rested for 2 weeks; no football. 2. Informed consent for conservative therapy was obtained. 3. Rehabilitation with team trainer including range of motion and strengthening exercises 4. Returned to football 4 weeks post injury when full, painless ROM, 5/5 strength achieved. 5. Now with 2 games remaining in season patient has had no further injury; He reports mild subjective decreased power (85% of baseline) and endurance in left lower extremity, but is able to play full game at expected level. 6. Orthopedic surgery consultation after football season to discuss possible delayed tendon repair versus continued conservative treatment.

Hemorrhagic prepatellar bursitis: a rare case report and review of the literature

Bursitis is a common cause of lower extremity pain in patients presenting to primary care physicians. However hemorrhagic prepatellar bursitis is considered to be one of the rare differential diagnoses of swellings around the knee and its diagnosis both clinically and radiologically can be difficult. We present a rare case report of a 50-year-old female patient with complaints of swelling and pain over her right knee for past one year. An initial diagnosis of prepatellar bursitis was made and aspiration of the swelling was done which revealed blood. After further investigations a final diagnosis of hemorrhagic prepatellar bursitis was made which was treated with complete excision and the patient was completely relieved of her symptoms.

Prepatellar Morel-Lavallée Lesion

Although the Morel-Lavalle lesion was originally described over 150 years ago and is a well known entity about the pelvis and femora, its occurrence in the prepatellar region has only recently been reported. While Tejwani et al asserted that prepatellar MLL and prepatellar bursitis can be readily distinguished clinically, the absence of prepatellar MLL from the literature until recently suggests that it may be under-diagnosed. Magnetic resonance imaging can be a helpful adjunct to the clinical examination in diagnosing MLL, primarily by confirming the precise extent of the fluid beyond the expected anatomic margins of the prepatellar bursa. Because both entities are initially treated in the same manner, MRI might be reserved for collections that fail to resolve following conservative therapy or in cases where the diagnosis is questioned. Serial percutaneous aspiration and sclerodesis should be considered in the management of recalcitrant collections or in the initial management of athletes depending on lesion size and range of motion.

Prepatellar bursitis

NICK PRICE explains why emergency nurses should understand the pathophysiology of the conditions with which patients present and examines that of prepatellar bursitis

MRI findings of prepatellar Morel-Lavallée effusions

To describe MR imaging characteristics and treatment options for prepatellar closed degloving injuries or Morel-Lavallée effusions. Imaging features are discussed that may aid in the distinguishing of this entity from "housemaid's knee" or prepatellar bursitis. MR images of four young wrestlers were reviewed by two attending radiologists and one fellow, and correlative clinical data were collected using the electronic medical database. MR images in all cases showed a unilocular, T2 hyperintense prepatellar collection extending beyond the normal boundaries of the prepatellar bursa. No necrotic fat or blood products were identified in the collections. Surgical pathology proving the absence of synovial tissue was available for one case, and differentiation of the collection from the adjacent bursa was confirmed visually by the surgeon in a second case. Although prepatellar hemorrhagic bursitis and Morel-Lavallée effusions share many imaging features, making a specific diagnosis in most cases is not necessary, as treatment is often similar for both entities.

The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults

To estimate the contribution of selected non-articular conditions (NACs) to pain severity and functional limitation in community-dwelling older adults with knee pain. Population-based, cross-sectional study of 745 adults aged 50 years and over with knee pain. Self-complete questionnaires, clinical history and physical examination were used to identify the presence of selected NACs that could cause pain around the knee. Regression analyses were used to compare levels of knee pain severity (0-20) and functional limitation (0-68) (Western Ontario and McMaster Universities osteoarthritis index physical function subscale [WOMAC-PF]), between those with one or more NACs and those with none (NACs-absent). Two hundred and seventy-three (36.6%) participants had at least one NAC: widespread pain, n=159; low back pain with index leg referral, n=102; full-leg pain, n=88; hip arthritis, n=65; prepatellar, infrapatellar or pes anserine bursitis, n=35. The NACs group had significantly higher levels of pain severity and functional limitation than the NACs-absent group: 8.2(+/-4.6) vs 5.4(+/-3.8) and 27.9(+/-15.8) vs 16.8(+/-13.2), respectively. The groups did not differ with respect to severity of radiographic osteoarthritis (ROA). Having one or more NACs accounted for a significant proportion of the variance in WOMAC scores, above that which could be explained by age, gender, body mass index and severity of ROA. NACs appear to be common in older adults with knee pain. They make a significant contribution to knee pain severity and functional limitation and are likely to represent additional, rather than alternative, causes of knee pain/functional limitation to osteoarthritis (OA). These factors should be taken into account in epidemiological studies of knee pain and OA.

Management of Morel-Lavallee Lesion of the Knee

Background The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion. Purpose To review the authors’ experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm. Study Design Case series; Level of evidence, 4. Methods Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a Morel-Lavallee lesion between 1993 and 2006. Their charts were retrospectively reviewed. Results The most common mechanism of injury was a shearing blow on the playing surface (81%). The most common motion deficit was active flexion (41%). The mean time for resolution of the fluid collection and achievement of full active flexion was 16.3 days. The mean number of practices missed was 1.5. The mean number of games missed was 0.1. Fourteen knees (52%) were treated successfully with compression wrap, cryotherapy, and motion exercises. Thirteen knees (48%) were treated with at least 1 aspiration, and 6 knees (22%) were treated with multiple aspirations for recurrent serosanguineous fluid collections. In 3 cases (11%), the Morel-Lavallee lesion was successfully treated with doxycycline sclerodesis after 3 aspirations failed to resolve the recurrent fluid collections; return to play was immediate thereafter in each case. Conclusion In football, Morel-Lavallee lesion of the knee usually occurs from a shearing blow from the playing field. Diagnosis is confirmed when examination reveals a large suprapatellar area of palpable fluctuance. Elite athletes are typically able to return to practice and game play long before complete resolution of the lesion. Recurrent fluid collections can occur, necessitating aspiration in approximately half the cases for successful treatment. Recalcitrant fluid collections can be safely and expeditiously treated with doxycycline sclerodesis.

Patellar osteomyelitis presenting as prepatellar bursitis

Peripatellar lesions causing knee pain include cellulitis, bursitis, synovitis, septic arthritis and patellar osteomyelitis. We present here two cases of patellar osteomyelitis which were misdiagnosed as prepatellar bursitis. Operative treatment was required for these lesions. Patellar osteomyelitis should always be considered when treating a peripatellar lesion, although it is very rare condition.

Knee Pain - Basketball

HISTORY: An 18-year-old basketball player presented to the primary care office after two days of increasing pain and swelling of the right knee. He recalled no specific injuries or trauma prior to onset of swelling and had no known history of knee problems. He had played basketball in the days prior to injury and he worked in a warehouse doing manual labor. His pain became increasingly worse and was exacerbated by deep knee bending while picking up boxes, twisting, and kneeling. He denied any rashes, bug bites, recent camping or travel. He had no night sweats, fevers, nausea, or vomiting. He was sexually active. PHYSICAL EXAMINATION: Examination on day of presentation showed a thin, well appearing young man. He was unable to fully weight bear on his right leg. Both knee flexion and extension were limited secondary to pain and effusion. There was a tense, four plus effusion of the right knee. It was not possible to appropriately evaluate Lachman's, anterior drawer and McMurry's secondary to the effusion. After arthrocentesis, second examination of the knee showed a negative McMurray's, Lachman's, and anterior drawer. DIFFERENTIAL DIAGNOSIS: ACL tear. Meniscal tear. Patellar subluxation. Prepatellar bursitis. Lyme arthritis. Chlamydial or gonorrheal arthritis. Juvenile rheumatoid arthritis. Systemic lupus erythematosus. TEST AND RESULTS: Knee arthrocentesis: 110 mL of straw colored fluid, no evidence of hemearthrosis. Cytology showed no malignant cells. Acute inflammatory cells were present. No crystals were identified. Fluid Culture showed no growth. Gram smear showed no organisms, there were three plus nutraphils and one plus mononuclear cells. Cell count showed 13200 WBC (94% segs, 3% bands, 2% lymphs, 1% monos). Rheumatoid factor <20 IU/mL. RPR non-reactive. Lyme Screen Positive. Lyme Western Blot IgG positive. Lyme Western Blot IgM negative. Gonorrhea and Chlamydia negative. ANA positive, fine speckled 1:80. Radiographs of knee showed a moderate suprapatellar effusion without evidence of acute fracture, malalignment or degenerative change. MRI showed very large effusion and small horizontal tear of anterior horn of medial meniscus. Re-questioning of patient after above results available revealed history of camping with tick bite 6 weeks prior to onset of symptoms. FINAL WORKING DIAGNOSIS: Lyme arthritis. TREATMENT AND OUTCOMES: The patient was treated with doxycycline 100 mg twice daily for one month. Rest, elevation and compression were recommended. He was told he could return to activities as soon as tolerable based on pain and range of motion. Symptoms resolved within three weeks and he was able to return to work and sports without limitation.

Sarcoidosis presenting as prepatellar bursitis

A 61-year-old woman complained of a subcutaneous mass in her right knee. MR images revealed a well-defined subcutaneous mass in the prepatellar region, containing some fluid and foci of short T2. The lesion showed some marginal contrast uptake after an administration of meglumine gadopentetate (Gd-DTPA), consistent with prepatellar bursitis. The pathological specimen, however, revealed subcutaneous sarcoidosis involving the bursa.

Osteomyelitis of the Patella in a Child: A Case Report

Osteomyelitis of the patella is a very rare condition that is generally considered a disease of childhood. The diagnosis is delayed frequently because of its rarity and variability in presentation. The authors report a case of patellar osteomyelitis, which presented as prepatellar bursitis in a child.

Pre-patellar bursitis as a first presentation of gout

We describe the case of a patient who presented with an acute pre-patellar bursitis, which did not improve with antibiotics. Aspiration of the bursa when it became fluctuant revealed urate crystals. Diagnosis was a rare first manifestation of gout, the occurrence of which had not been reported previously in orthopaedic literature. We highlight the importance of aspiration in the management of bursitis and its importance when gout is suspected, especially in one in whom non-steroidal anti-inflammatory drugs (NSAIDs) has recently been stopped. It is important to appreciate that the presence of crystals does not exclude the presence of infection. Bursitis can be caused by gouty crystals, but an infective cause of bursitis can result in secondary gout. Uric acid levels are not useful for the management of the first presentation of gout. We propose a simple algorithm for the management of acute bursitis.

Too young to be having a heart attack

Too young to be having a heart attack

Osteomyelitis of the patella.

Osteomyelitis of the patella is an uncommon infection that is primarily a disease of childhood. The diagnosis frequently is delayed because of its rarity and variable presentation, which may be acute with systemic signs or insidious with mild local signs. The diagnosis should be considered in patients with persistent peripatellar pain and swelling, cellulitis, septic prepatellar bursitis, and septic arthritis of the knee that does not respond to standard treatment. Treatment is identical to the treatment of osteomyelitis at other locations. The outcome is favorable in the child regarding range of motion and activity, although there may be persistent changes radiographically.

Massive prepatellar bursitis in post-polio residual paralysis: A case report.

We report a case of post-polio residual paralysis, an eighteen-year old girl who was ambulatory on all four limbs and presented to us with a massive pre-patellar bursitis on her left knee.