Housewife's Knee (Prepatellar Bursitis): Causes, Symptoms, Diagnosis, and Treatment

What is a Housewife's Knee?

Commonly known as "housewife's knee," this condition is medically termed prepatellar bursitis, an inflammation of the bursa located just in front of the kneecap (patella), typically caused by repetitive kneeling or direct trauma.

Understanding "Housewife's Knee": The Scientific Perspective

While the term "housewife's knee" is a colloquialism, it accurately describes a common occupational hazard for individuals whose activities involve prolonged or repetitive kneeling. Medically, this condition is known as prepatellar bursitis. To understand it, we must first grasp the role of bursae in the body. Bursae are small, fluid-filled sacs located throughout the body, particularly around joints. Their primary function is to reduce friction between bones, tendons, and muscles during movement.

The prepatellar bursa is situated between the patella (kneecap) and the skin. Its strategic location helps the skin glide smoothly over the kneecap during knee flexion and extension. When this bursa becomes inflamed, it swells with excess fluid, leading to the characteristic symptoms of "housewife's knee."

Causes and Risk Factors

Prepatellar bursitis primarily arises from mechanical irritation, though other factors can contribute.

• Repetitive Kneeling: This is the most common cause. Activities that require prolonged or repeated kneeling, such as housework (scrubbing floors), gardening, plumbing, roofing, carpet laying, or even certain sports like wrestling, can put excessive pressure and friction on the prepatellar bursa, leading to inflammation.
• Direct Trauma: A direct blow or fall onto the kneecap can also cause acute prepatellar bursitis.
• Infection (Septic Bursitis): While less common, the prepatellar bursa can become infected if bacteria enter through a cut, scrape, or puncture wound over the kneecap. This is a more serious condition requiring prompt medical attention.
• Underlying Inflammatory Conditions: Less frequently, systemic inflammatory conditions like rheumatoid arthritis or gout can predispose individuals to bursitis, including prepatellar bursitis.

Signs and Symptoms

The symptoms of prepatellar bursitis typically develop gradually over time, though acute cases from trauma can appear suddenly.

• Pain: Localized pain over the front of the kneecap, often worse with direct pressure, kneeling, or squatting.
• Swelling: A noticeable, soft lump or swelling directly over the kneecap. This swelling can range from subtle to quite prominent.
• Tenderness: The area over the bursa is often tender to the touch.
• Warmth and Redness: In cases of significant inflammation or infection (septic bursitis), the skin over the bursa may feel warm to the touch and appear red.
• Reduced Range of Motion: While the knee joint itself is typically not affected, severe swelling can sometimes limit full knee flexion or extension due to pain or mechanical obstruction.
• Fever and Chills: These symptoms are a strong indicator of an infection (septic bursitis) and warrant immediate medical evaluation.

Diagnosis

Diagnosing prepatellar bursitis typically involves a thorough clinical evaluation.

• Medical History: The physician will inquire about your symptoms, activities, and any history of injury or underlying medical conditions.
• Physical Examination: A physical exam will focus on the affected knee, checking for pain, swelling, tenderness, warmth, redness, and range of motion. The characteristic localized swelling over the kneecap is a key diagnostic sign.
• Imaging Studies:
  • X-rays are usually not necessary to diagnose bursitis itself, but they may be used to rule out other conditions like fractures or arthritis.
  • MRI (Magnetic Resonance Imaging) may be considered in complex cases or when other diagnoses, such as meniscus tears or ligament injuries, need to be excluded.
• Fluid Aspiration (Bursa Aspiration): If infection (septic bursitis) is suspected, a small amount of fluid may be aspirated (drawn out) from the bursa with a needle. This fluid can then be sent for laboratory analysis to check for bacteria, white blood cells, or crystals (indicating gout).

Treatment Approaches

Treatment for prepatellar bursitis aims to reduce inflammation, alleviate pain, and prevent recurrence.

• Conservative Management: This is the first line of treatment for most cases.

  • RICE Protocol: Rest the affected knee by avoiding activities that aggravate it, particularly kneeling. Apply Ice packs to the area for 15-20 minutes several times a day to reduce swelling and pain. Use a Compression bandage to help reduce swelling. Elevate the leg above heart level when resting.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen or naproxen can help reduce pain and inflammation.
  • Activity Modification: Avoid kneeling or positions that put direct pressure on the bursa.
  • Knee Pads: Wearing protective knee pads during activities that involve kneeling is crucial for prevention and management.
  • Physical Therapy: Once acute symptoms subside, a physical therapist can provide exercises to improve knee strength, flexibility, and biomechanics, which can help prevent recurrence.

• Medical Interventions:

  • Corticosteroid Injections: For persistent or severe inflammation, a corticosteroid injection directly into the bursa can provide significant pain relief and reduce swelling. This is typically done under sterile conditions.
  • Antibiotics: If the bursa is infected (septic bursitis), a course of oral or intravenous antibiotics will be prescribed based on the type of bacteria identified.
  • Aspiration: Draining the excess fluid from the bursa with a needle can provide immediate relief from swelling and pressure, especially in large effusions.

• Surgical Intervention:

  • Bursectomy: Surgical removal of the prepatellar bursa (bursectomy) is rarely necessary and is reserved for chronic, recurrent cases that have failed all other conservative and medical treatments, or for persistent septic bursitis that does not respond to antibiotics and aspiration.

Prevention Strategies

Preventing "housewife's knee" largely involves modifying activities and protecting the bursa.

• Use Knee Pads: This is the most effective preventive measure for anyone whose activities involve kneeling.
• Take Frequent Breaks: If kneeling is unavoidable, take regular breaks to change positions and relieve pressure on the knees.
• Vary Positions: Alternate between kneeling, squatting, and standing when performing tasks.
• Maintain Good Posture and Body Mechanics: Proper body mechanics can reduce overall stress on joints.
• Strengthen Surrounding Musculature: Strong quadriceps, hamstrings, and gluteal muscles can help support the knee joint and absorb shock, though their direct impact on prepatellar bursitis prevention is less direct than activity modification.
• Regular Stretching: Maintaining flexibility in the knee and surrounding muscles can also contribute to overall joint health.
• Protect Abrasions: Promptly clean and cover any cuts or scrapes over the kneecap to prevent bacterial entry and potential septic bursitis.

When to Seek Medical Attention

While many cases of prepatellar bursitis resolve with conservative home treatment, it's important to know when to consult a healthcare professional.

• Severe Pain: If the pain is intense or rapidly worsening.
• Rapid Swelling: Sudden and significant swelling over the kneecap.
• Signs of Infection: Redness, warmth, fever, chills, or red streaks spreading from the knee. These are urgent signs of septic bursitis.
• Inability to Bear Weight: If you cannot put weight on your leg.
• Symptoms Persist: If your symptoms do not improve after a week or two of conservative home treatment.
• Recurrent Episodes: If you experience repeated episodes of prepatellar bursitis.