Knee Bursitis: Understanding Housemaid's Knee, Causes, Symptoms, and Treatment

What is the nickname for bursitis in the knee?

The most common nickname for bursitis affecting the knee, particularly the prepatellar bursa, is "Housemaid's Knee." This term refers to the condition often caused by prolonged or repetitive kneeling.

Introduction to Bursitis in the Knee

Bursitis is an inflammatory condition affecting the bursae, which are small, fluid-filled sacs located throughout the body. These sacs act as cushions between bones, tendons, muscles, and skin, reducing friction during movement. When a bursa becomes inflamed, it swells and can cause pain, tenderness, and limited mobility in the affected joint. The knee joint, due to its complex structure and frequent use, is particularly susceptible to bursitis.

The Nickname: "Housemaid's Knee"

The term "Housemaid's Knee" (medically known as prepatellar bursitis) specifically refers to the inflammation of the prepatellar bursa, located directly in front of the kneecap (patella). This nickname arose historically because individuals whose occupations involved extensive kneeling, such as housemaids scrubbing floors, carpet layers, roofers, or plumbers, were highly prone to developing this condition due to chronic pressure and friction on the bursa.

While "Housemaid's Knee" is the most prevalent nickname, other less common occupational-related terms exist for bursitis in different knee bursae:

• "Clergyman's Knee": Historically used for infrapatellar bursitis (inflammation of the bursa below the kneecap), also associated with kneeling.
• "Carpet Layer's Knee": Another contemporary term often used interchangeably with "Housemaid's Knee" to describe prepatellar bursitis.

Anatomy of Knee Bursae

The knee joint contains several bursae, each vulnerable to inflammation. Understanding their locations is key to differentiating types of knee bursitis:

• Prepatellar Bursa: Situated superficially over the kneecap. This is the bursa involved in "Housemaid's Knee." Its inflammation is often due to direct trauma or prolonged kneeling.
• Infrapatellar Bursae: There are two infrapatellar bursae:
  • Superficial Infrapatellar Bursa: Lies between the skin and the patellar tendon, just below the kneecap.
  • Deep Infrapatellar Bursa: Located between the patellar tendon and the tibia (shin bone).
• Pes Anserine Bursa: Located on the inner side of the knee, about 2-3 inches below the joint line, where the tendons of the sartorius, gracilis, and semitendinosus muscles insert. Inflammation here is known as pes anserine bursitis, often seen in runners or those with osteoarthritis.

Causes and Risk Factors

Bursitis in the knee typically results from:

• Repetitive Pressure and Friction: Prolonged or repeated kneeling, crawling, or direct pressure on the kneecap.
• Acute Trauma: A direct blow or fall onto the knee.
• Overuse and Strain: Repetitive activities, especially those involving squatting, jumping, or sudden changes in direction.
• Infection: Bacterial infection of the bursa (septic bursitis), which can occur from a cut or scrape over the bursa. This is a more serious condition requiring immediate medical attention.
• Underlying Medical Conditions: Conditions like rheumatoid arthritis, gout, pseudogout, or diabetes can increase the risk of bursitis.
• Improper Biomechanics: Poor form during exercise, muscle imbalances, or inadequate flexibility can contribute to abnormal stress on the knee bursae.

Signs and Symptoms

The symptoms of knee bursitis can vary depending on the affected bursa and the cause, but commonly include:

• Pain: Often worsened with movement, kneeling, or direct pressure.
• Swelling: Visible lump or puffiness over the affected area of the knee.
• Tenderness: Pain upon touching the inflamed bursa.
• Warmth and Redness: Especially indicative of septic bursitis.
• Limited Range of Motion: Pain may restrict full flexion or extension of the knee.
• Fever and Chills: Strong indicators of septic bursitis.

Diagnosis

Diagnosis of knee bursitis typically involves:

• Physical Examination: Your healthcare provider will inspect and palpate the knee, assessing for swelling, tenderness, warmth, and range of motion.
• Medical History: Discussion of your symptoms, activities, and any relevant medical conditions.
• Imaging Tests:
  • X-rays: Primarily used to rule out bone injuries or arthritis.
  • Ultrasound: Can visualize fluid accumulation within the bursa.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, helping to differentiate bursitis from other conditions.
• Fluid Aspiration (Bursa Aspiration): If infection is suspected, fluid may be drawn from the bursa with a needle and sent for laboratory analysis to check for bacteria or crystals (e.g., gout).

Treatment and Management

Treatment for knee bursitis generally focuses on reducing inflammation and pain.

• Conservative Approaches:
  • RICE Protocol: Rest, Ice, Compression, and Elevation.
  • Activity Modification: Avoiding activities that aggravate the knee, especially kneeling.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help reduce pain and inflammation.
  • Physical Therapy: Exercises to improve flexibility, strengthen surrounding muscles (quadriceps, hamstrings, glutes), and correct biomechanical imbalances.
  • Knee Pads: Using protective padding during activities that require kneeling.
• Medical Interventions:
  • Corticosteroid Injections: An anti-inflammatory medication injected directly into the bursa to reduce swelling and pain.
  • Antibiotics: Prescribed for septic bursitis, often requiring a course of oral or intravenous antibiotics.
  • Aspiration: Draining excess fluid from the bursa to relieve pressure and pain.
• Surgical Intervention (Bursectomy): Rarely needed, but in chronic, severe, or recurrent cases that don't respond to conservative treatment, surgical removal of the bursa may be considered.

Prevention Strategies

Preventing knee bursitis, particularly "Housemaid's Knee," involves minimizing stress on the knee bursae:

• Use Knee Pads: Essential for occupations or activities involving prolonged kneeling.
• Take Frequent Breaks: If kneeling is unavoidable, take regular breaks to stand and move.
• Maintain a Healthy Weight: Reduces overall stress on the knee joints.
• Strengthen Leg Muscles: Strong quadriceps, hamstrings, and glutes provide better support for the knee.
• Improve Flexibility: Regular stretching of the quadriceps, hamstrings, and hip flexors can help.
• Proper Body Mechanics: Learn and practice correct form for lifting, squatting, and other movements to distribute load effectively.
• Address Underlying Conditions: Manage chronic conditions like arthritis or gout that can predispose you to bursitis.

When to See a Doctor

While many cases of knee bursitis resolve with conservative home care, it's important to seek medical attention if you experience:

• Severe pain or swelling.
• Inability to bend or straighten your knee.
• Fever, chills, or excessive warmth and redness around the knee, which could indicate a serious infection (septic bursitis).
• Symptoms that do not improve after a week of self-care.
• Recurrent episodes of bursitis.