Patellar Bursitis: Symptoms, Causes, and When to Seek Medical Care

What are the symptoms of bursitis in the patella?

Patellar bursitis, often referred to as "housemaid's knee" or "carpenter's knee," primarily manifests as pain, swelling, and tenderness over the front of the kneecap due to inflammation of the bursa sacs surrounding the patella.

Understanding Patellar Bursitis

Bursitis is a common condition characterized by the inflammation of a bursa, a small, fluid-filled sac that acts as a cushion between bones, tendons, muscles, and skin. Its primary function is to reduce friction during movement. Around the patella (kneecap), there are several bursae, the most commonly affected being the prepatellar bursa (located directly in front of the kneecap) and, less frequently, the infrapatellar bursae (superficial and deep, located below the kneecap). Inflammation typically results from repetitive kneeling, direct trauma, or prolonged pressure, leading to the distinct symptoms outlined below.

Key Symptoms of Patellar Bursitis

The symptoms of patellar bursitis can vary in intensity depending on the degree of inflammation and whether an infection is present (septic bursitis).

• Pain:

  • Location: The pain is typically localized to the front of the kneecap. For prepatellar bursitis, it's directly over the patella; for infrapatellar bursitis, it's just below the patella.
  • Nature: It can range from a dull ache to a sharp pain, especially with direct pressure or movement.
  • Aggravating Factors: Pain often worsens with activities that involve direct pressure on the knee, such as kneeling, crawling, or prolonged sitting with bent knees. It may also intensify with walking, running, or climbing stairs, though usually less so than with direct pressure.

• Swelling:

  • Appearance: This is one of the most noticeable symptoms, presenting as a visible lump or puffiness directly over the kneecap. The swelling can range from mild to significant, sometimes resembling a "golf ball" or "egg" under the skin.
  • Consistency: The swollen area may feel soft and boggy due to fluid accumulation within the bursa.

• Tenderness:

  • On Palpation: The affected area will be tender to the touch. Even light pressure on the kneecap can elicit pain.

• Warmth and Redness:

  • Inflammation Signs: The skin over the inflamed bursa may feel warm to the touch and appear red. These signs are indicative of the inflammatory process.
  • Septic Bursitis: If the bursitis is caused by an infection (septic bursitis), warmth and redness will typically be more pronounced and may be accompanied by fever, chills, and general malaise. This is a medical emergency requiring immediate attention.

• Restricted Movement:

  • Decreased Range of Motion: While the knee joint itself may not be directly affected, the significant swelling and pain can limit the full range of motion, making it difficult to fully bend or straighten the knee. This is often due to mechanical impingement from the swollen bursa or pain inhibition.

• Palpable Mass/Lump:

  • Fluid Accumulation: A fluid-filled sac or lump can often be felt directly beneath the skin over the kneecap. This is the inflamed bursa itself, distended with excess fluid.

Differentiating Patellar Bursitis from Other Knee Conditions

It's important to note that while the symptoms are characteristic, they can sometimes overlap with other knee conditions. Unlike injuries to the knee joint itself (e.g., meniscus tears, ligament sprains), the pain and swelling of patellar bursitis are typically superficial and localized to the front of the kneecap, rather than deep within the joint. Tendinitis (e.g., patellar tendinitis) causes pain in the tendon itself, which is usually more localized to the tendon's attachment points and often worse with specific movements or loading.

When to Seek Medical Attention

While many cases of patellar bursitis can improve with conservative management, it's crucial to seek medical attention if you experience:

• Severe or rapidly worsening pain and swelling.
• Significant warmth and redness extending beyond the bursa.
• Fever, chills, or general feelings of being unwell.
• Open wounds or skin breaks near the bursa.
• Inability to bear weight on the affected leg.
• Symptoms that do not improve with rest and home care within a few days.

These signs could indicate a septic bursitis, which requires urgent medical intervention to prevent serious complications. A healthcare professional can accurately diagnose the condition through physical examination and, if necessary, imaging studies or fluid aspiration from the bursa.

Conclusion

Patellar bursitis presents with a distinct set of symptoms, primarily pain, swelling, and tenderness directly over the kneecap, often exacerbated by direct pressure or kneeling. Understanding these signs is crucial for early recognition and appropriate management. While many cases resolve with conservative treatment, vigilance for signs of infection and timely medical consultation are paramount to ensure proper diagnosis and prevent potential complications.