Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Prepatellar Bursitis

SYMPTOMS

There is gradual or acute onset of localised swelling and inflammatory signs over the patella.

AETIOLOGY

The bursitis can develop from a direct trauma and bleeding or from repetitive stress, when synovial fluid fills the bursa (housemaid’s knee) or when pus from infected superficial skin wounds penetrates the bursa.

CLINICAL FINDINGS

There is a localised tender and fluctuating swelling anterior to the patella but no effusion on the knee.

INVESTIGATIONS

X-ray is normal. MRI or ultrasound will confirm.

TREATMENT

If the swelling is caused by bleeding or temporary over-use (kneeling on hard ground) this injury responds to conservative treatment including cold and compression and avoidance of direct impact to the knee. There is seldom an indication for surgery. If it is caused by infection, antibiotics and open drainage of the bursa should be considered.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the cause of the bursitis and treatment.

EXERCISE PRESCRIPTION

Rest if the cause is infection. Otherwise most sports could be allowed, but avoid direct impact on the knee.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Soft tissue tumour (rare). Septic bursitis can develop into a much more dangerous septic arthritis by penetration of bacteria into the knee joint via the blood.

PROGNOSIS

Good-Fair. Once the bursa has been affected, it will be more sensitive to further knocks and the bursitis can therefore recur independent of the initial cause.

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