Ultrasound-Guided Cortisone Injections for Prepatellar Bursitis

 

Introduction

Prepatellar bursitis is a condition characterised by inflammation of the prepatellar bursa, a fluid-filled sac located in front of the kneecap (patella). The prepatellar bursa serves as a cushion, reducing friction between the skin and the underlying bone. When irritated or inflamed, it can lead to swelling, pain, and restricted knee movement, affecting daily activities and mobility.

Prepatellar bursitis is commonly referred to as “housemaid’s knee”, as it frequently occurs in individuals who spend prolonged periods kneeling. The condition can be caused by repetitive pressure, trauma, infection, or inflammatory diseases such as rheumatoid arthritis.

For individuals experiencing persistent discomfort, ultrasound-guided cortisone injections may be considered as a targeted treatment to reduce inflammation and alleviate pain. This blog explores the anatomy, pathology, causes, symptoms, diagnosis, and treatment of prepatellar bursitis, with a detailed discussion on the mechanism of cortisone injections and their role in symptom management.

Anatomy of the Prepatellar Bursa

Structure and Function

The prepatellar bursa is one of several bursae around the knee joint. It is a thin, synovial-lined sac filled with fluid, positioned between the patella (kneecap) and the overlying skin.

The primary functions of the prepatellar bursa include:

  • Reducing friction between the skin and patella during movement.
  • Acting as a cushion to absorb mechanical stress.
  • Facilitating smooth movement of the knee, particularly during kneeling.

When the bursa becomes inflamed or irritated, excessive fluid accumulates, leading to prepatellar bursitis.

Pathology of Prepatellar Bursitis

Prepatellar bursitis occurs when the synovial lining of the bursa becomes inflamed, leading to:

  • Excess fluid production within the bursa.
  • Swelling and pain around the kneecap.
  • Restricted movement due to discomfort.

The underlying causes of inflammation can be mechanical, infectious, or inflammatory in nature.

Types of Prepatellar Bursitis

  1. Non-infectious (Aseptic) Prepatellar Bursitis — Caused by repetitive stress, trauma, or underlying inflammatory conditions.
  2. Infectious (Septic) Prepatellar Bursitis — Occurs when the bursa becomes infected due to bacterial infiltration, requiring medical intervention.

Causes of Prepatellar Bursitis

Prepatellar bursitis can develop due to a variety of factors:

1. Repetitive Kneeling (Chronic Pressure)

  • Prolonged or frequent kneeling, commonly seen in carpet layers, plumbers, cleaners, and gardeners, increases the risk of chronic irritation.

2. Direct Trauma

  • A sudden impact to the front of the knee, such as a fall or a blow, can trigger inflammation and fluid accumulation in the bursa.

3. Infection (Septic Bursitis)

  • A skin cut, scrape, or puncture wound near the knee can introduce bacteria into the bursa, leading to an infection.
  • Common bacterial causes include Staphylococcus aureus and Streptococcus species.

4. Inflammatory Conditions

  • Systemic conditions such as rheumatoid arthritis, gout, or pseudogout may cause bursal inflammation.
  • Gout-related bursitis occurs due to the accumulation of uric acid crystals.

5. Overuse or Strain

  • Repetitive bending, squatting, or excessive knee movement can contribute to bursal irritation.

Symptoms of Prepatellar Bursitis

Common Symptoms

  • Swelling in front of the knee (visible fluid accumulation).
  • Pain and tenderness over the kneecap.
  • Redness and warmth (suggesting inflammation or infection).
  • Restricted knee movement due to discomfort.
  • Difficulty kneeling or walking for prolonged periods.

Symptoms of Septic Bursitis

  • Fever and chills.
  • Severe pain with increasing redness and warmth.
  • Pus drainage from the bursa (in severe infections).
  • Generalised feeling of being unwell.

Diagnosis of Prepatellar Bursitis

A clinician at Alton Pain Clinic will conduct a thorough clinical assessment and imaging studies to confirm the diagnosis.

Clinical Examination

  • History and symptom analysis — Evaluating knee pain, swelling, and potential causes.
  • Physical examination — Checking for tenderness, swelling, and range of motion.

Diagnostic Tests

  1. Ultrasound Scan — Helps assess bursal swelling and detect fluid accumulation.
  2. Aspiration and Fluid Analysis — If infection is suspected, the clinician may extract fluid for laboratory testing to check for bacteria, white blood cells, or crystals (gout-related).

Treatment Options for Prepatellar Bursitis

Conservative Management

For mild to moderate cases, non-surgical treatments may be effective:

  1. Rest and Activity Modification — Avoiding kneeling or excessive pressure on the knee.
  2. Ice Therapy — Applying ice packs to reduce swelling and pain.
  3. Compression and Elevation — Using knee braces or support bandages.
  4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) — Such as ibuprofen to relieve pain.
  5. Aspiration — Removing excess fluid via a needle to reduce swelling.

Ultrasound-Guided Cortisone Injections for Prepatellar Bursitis

For individuals with persistent pain and inflammation, ultrasound-guided cortisone injections may be recommended to reduce inflammation and improve mobility.

Mechanism of Action of Cortisone Injections

Cortisone injections work by:

  • Reducing inflammation — Suppressing inflammatory chemicals (cytokines and prostaglandins) in the bursa.
  • Minimising pain — By decreasing swelling and irritation.
  • Enhancing mobility — Allowing improved knee function.

Ultrasound Guidance Benefits

At Alton Pain Clinic, ultrasound is used to:
✔ Ensure precise cortisone injection placement.
✔ Minimise discomfort and side effects.
✔ Enhance treatment effectiveness.

Procedure Overview

  1. Preparation — The clinician cleans the area and applies a local anaesthetic.
  2. Ultrasound Guidance — Real-time imaging ensures accurate injection placement.
  3. Cortisone Injection — The medication is injected into the inflamed bursa.
  4. Post-Injection Care — Patients are advised to avoid strenuous activities for 24–48 hours.

Why Choose Alton Pain Clinic for Prepatellar Bursitis Treatment?

✔ Expert clinicians specialising in musculoskeletal conditions.
✔ Ultrasound-guided injections for precise treatment.
✔ Personalised care plans tailored to individual needs.

Conclusion

Prepatellar bursitis can significantly affect knee function, especially in individuals exposed to repetitive kneeling or trauma. Ultrasound-guided cortisone injections provide a targeted approach to managing inflammation and pain, allowing patients to regain mobility and comfort.

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