by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Housemaids knee

Bursa is the Greek word for 'a wine skin'.

A bursa is a thin sack filled with a small amount of bursal fluid, a lubricating substance secreted by the lining cells of the bursa. A bursa, because of this "slippery" property allows different tissues such as muscle, tendon, and skin to slide over bony surfaces without catching. When a bursa becomes inflamed, the condition is called "bursitis."

The prepatellar bursa lies in front of the patella (knee cap).

Prepatellar bursitis is commonly called 'housemaid's knee'. The bursa becomes tender and swollen, and movement of the joint may become restricted. If the bursa becomes infected it may become red, hot, and painful.

Prepatellar bursitis is usually caused by repeated friction between the skin and the patella. It can also be caused by injury, infection, or underlying inflammatory condition.

The condition occurs in situations where someone is repeatedly on their knees. It used to be characteristic of housemaids who spent a lot of their working day on their knees cleaning - hence the name. Now it's more common among those who have to spend time on their knees at work, such as carpet layers, plumbers, electricians, and gardeners.

The symptoms of prepatellar bursitis or knee bursitis are a swelling over the kneecap which can cause limited range of motion of the joint. The swelling occurs inside the bursa, not the knee joint. Symptoms of prepatellar bursitis are usually aggravated by kneeling, and relieved by rest.

Treatment first should be aimed at excluding infection. Infected bursae need to be treated with antibiotics. If the bursa is not infected then the treatment involves rest, cold and heat therapy, and non-steroidal anti-inflammatory drugs. Wearing a knee pad can help prevent this. Fluid may need to be aspirated from the bursa, and glucocorticoid (steroid) may be injected. Stubborn cases may respond to ultrasound-guided needle tenotomy with platelet-rich plasma, a minimally invasive, highly effective procedure. Surgery is rarely needed.

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