The condition commonly known as “housemaid’s knee” is medically termed prepatellar bursitis. This name originated from the historical observation that individuals whose occupations required frequent, prolonged kneeling—such as housemaids cleaning floors—were particularly susceptible to the injury. Prepatellar bursitis is an inflammatory condition that results from irritation or trauma to a small, fluid-filled sac located at the front of the knee.
Prepatellar Bursitis: The Medical Explanation
A bursa is a small, jelly-like sac that is present throughout the body, acting as a cushion between bones, tendons, and skin to reduce friction during movement. The prepatellar bursa is uniquely positioned between the kneecap, or patella, and the overlying skin. Its normal function is to allow the skin to glide smoothly over the kneecap as the knee bends and straightens.
Inflammation of this sac, known as bursitis, occurs when the bursa becomes irritated and produces an excessive amount of fluid. This fluid buildup causes the sac to swell, placing pressure on the adjacent parts of the knee. The mechanism of injury is often chronic microtrauma, where repetitive pressure or friction, such as long periods of kneeling, continually irritates the bursa.
The condition can also arise from a single, acute incident, like a direct blow or a fall onto the kneecap. Individuals in occupations like carpet laying, plumbing, or mining are at a greater risk due to the nature of their work requiring frequent kneeling.
Recognizing the Symptoms
The most noticeable sign of prepatellar bursitis is a rapid swelling localized directly over the front of the kneecap. This swelling often feels soft or squishy to the touch and can sometimes cause the knee to appear visibly bulging. In addition to the visible swelling, the area is tender to the touch, and patients may experience pain, particularly when attempting to kneel or fully bend the knee.
If the inflammation is caused by an infection, known as septic bursitis, additional symptoms will be present. The skin over the bursa may become warm and red, and the patient might experience systemic signs like fever or chills. Diagnosis is generally made through a physical examination, where a healthcare provider assesses the swelling, tenderness, and range of motion.
Imaging tests are not always necessary but may be used to confirm the diagnosis or rule out other issues. An X-ray might be ordered to ensure there is no underlying fracture or bony problem contributing to the symptoms. If an infection is suspected, a procedure called aspiration is performed to draw fluid from the bursa with a needle, and this fluid is then sent to a lab for analysis.
Treatment and Recovery
Initial treatment for non-infected prepatellar bursitis focuses on conservative management to reduce inflammation and pain. This often begins with the RICE protocol: Rest, avoiding activities that worsen symptoms like kneeling; Ice, applying a cold compress to the area for about 20 minutes several times a day; Compression, using a wrap to help reduce swelling; and Elevation of the affected leg. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are commonly used to manage pain and decrease the inflammatory response.
If the swelling and pain do not respond adequately to these conservative measures, more invasive medical procedures may be considered. A doctor may perform bursal aspiration, which involves draining the excess fluid from the sac with a needle to relieve pressure. Following aspiration, a corticosteroid, a stronger anti-inflammatory medication, may be injected into the bursa to further reduce inflammation.
When the bursitis is determined to be septic, the treatment approach changes significantly. The cornerstone of care for septic bursitis is antibiotic therapy, which must be started promptly after infection is confirmed or strongly suspected. In cases where the infection is severe or does not respond to antibiotics alone, surgical drainage or even removal of the entire bursa, called a bursectomy, may be necessary. The typical recovery timeline for non-septic bursitis treated conservatively is usually a few weeks, though chronic cases can sometimes take months to fully resolve.
Avoiding Future Incidents
Preventing the recurrence of prepatellar bursitis centers on modifying activities that place repetitive pressure on the knee. For individuals whose work or hobbies involve frequent kneeling, the mandatory use of thick foam cushions or professional-grade knee pads is highly recommended. This cushioning acts as a barrier, significantly reducing the compressive and sheer forces on the prepatellar bursa. It is also beneficial to incorporate frequent breaks from kneeling to stretch the legs and change position regularly. For those who participate in sports that involve landing on the knees, like wrestling or volleyball, protective knee padding should be worn consistently.