What is Prepatellar Bursitis or Beat Knee or Carpet Layer's Knee?
Prepatellar bursitis is an inflammation of the prepatellar bursa which is located in front of knee. It is also called as Carpet Layer's Knee or Housemaid's Knee. This condition can develop either due to pressure or a direct injury to the knee. Symptoms of the condition are swelling of the knee. The knee is tender to touch, although the pain and swelling do not hamper motion of knee. Trauma to the knee can be acute or chronic. Prepatellar bursitis generally happens to people who are required to repeatedly kneel in the course of their occupation. Clinical history and a detailed physical assessment usually confirm the diagnosis. Treatment of this condition is dependent on the intensity of symptoms. If the injury is mild, then adequate rest and frequent icing of knee may be enough. In case of sepsis, IV antibiotics, procedure for irrigation of bursa, and even a bursectomy can be done.
Signs of Prepatellar Bursitis or Beat Knee or Carpet Layer's Knee
- Pain along with tenderness to touch on the patella.
- Swelling, warmth, and redness in the region of the kneecap.
- Pain with pressure on swelling.
- Painful kneeling.
- Presence of cellulitis is cases of sepsis.
- Presence of abscess or a fluid filled bulge on the patella.
- In case of a chronic prepatellar bursitis, a mobile and tender lump is present beneath the skin of the kneecap.
- Flexing and extending the knee results in crepitus.
- The range of motion of the knee is generally within normal limits.
Causes of Prepatellar Bursitis or Beat Knee or Carpet Layer's Knee
Bursa is a small pocket which is filled with synovial fluid. It acts as a lubricant and reduces friction between surrounding structures. Prepatellar bursa is one of the several bursae present in knee joint. Prepatellar bursa is present between the kneecap and skin. Inflammation of bursa gives rise to the condition prepatellar bursitis. As the walls of the bursae are quite thin, they get inflamed quite easily when irritated. The prepatellar bursa causes knee pain most commonly.
Prepatellar bursitis of an acute nature may be caused as a result of direct blow to knee or falling on to knee resulting in rupture of blood vessels and bleeding into bursa giving rise to swelling of the knee. This further causes inflammation in the bursal walls resulting in its thickening and causing tenderness. The tenderness may persist even after the swelling has decreased. Bursitis of an acute nature may be caused due to an infection from an injury. A skin abrasion over the kneecap results in spread of bacteria in the fluid present in the prepatellar bursa resulting in an infection. Chronic form of bursitis may be caused due to repetitive injury to the knee e.g., repeated kneeling or an occupation which involves putting pressure on the kneecap resulting in thickening of the bursal walls causing irritation. Other causes of prepatellar bursitis include gout, CREST syndrome, diabetes, excessive alcohol consumption, chronic obstructive pulmonary disease. Some cases are termed as idiopathic, although they may be as a result of an old trauma or injury which the individual may even not remember. Tuberculosis can also cause this infection, although it is very rare.
Treatment for Prepatellar Bursitis or Beat Knee or Carpet Layer's Knee
Acute Prepatellar Bursitis:
- Rest, ice, compression and elevation is beneficial.
- NSAIDs can also be given to the patient.
- Heating pads also help.
Chronic Prepatellar Bursitis:
- Movements of the knee such as with kneeling need to be avoided to prevent aggravation of the condition. If kneeling cannot be avoided as in specific occupations or athletes playing contact sports, then knee pads or padded knee supports may be required.
- In case of persistent swelling, aspiration of some of the fluid within the bursa along with cortisone injections can be done to improve the swelling.
- If the bursa becomes infected, then antibiotics should be given.
- After the treatment of bursitis is completed, comprehensive rehab should be undertaken to improve joint mechanics and reduce chronic pain.
- Patients who do not respond to the above-mentioned measures may need surgical procedures consisting of removal of the bursa. This procedure is called bursectomy.