Prepatellar bursitis is an inflammation of the prepatellar bursa on the front of the knee. It is characterized by swelling of the knee, which can feel tender to the touch but does not limit the range of knee motion. This is most often due to trauma to the knee, either by an acute event or chronic trauma over time. Thus, prepatellar bursitis usually occurs among individuals whose profession needs to often kneel.
The definitive diagnosis of the condition can usually be done after clinical history and physical examination has been obtained, although determining whether sepsis bursitis is not that simple. Treatment of prepatellar bursitis depends on the severity of the symptoms. A mild case may only require rest and knee lining. A number of different treatment options have been used for severe septic cases, including intravenous antibiotics, surgical irrigation bursa, and bursectomy.
Video Prepatellar bursitis
Signs and symptoms
The main symptom of prepatellar bursitis is swelling of the area around the kneecap. It generally produces no significant pain unless pressure is applied directly to the swelling. Swelling areas may be red (erythema), warm to the touch, or surrounded by cellulitis, especially if the area has been infected. In such cases, bursitis is often accompanied by fever. Unlike arthritis, prepatellar bursitis generally does not affect the range of knee motion, although it can cause discomfort when the knee is completely bent. Flexion and knee extension can cause crepitation.
Maps Prepatellar bursitis
Cause
In human anatomy, bursa is a small bag of synovial fluid. The goal is to reduce friction between adjacent structures. The prepatellar bursa is one of several bursae knee joints, and lies between the patella and the skin. Prepatellar bursitis is the inflammation of this bursa. Bursae easily inflamed when annoyed, because their walls are very thin. Along with the anserine bubble exchanges, the prepatellar bursa is one of the most common bursae that causes knee pain when it is inflamed.
Prepatellar bursitis is caused by one example of acute trauma to the knee, or minor trauma that repeats in the knee. Trauma can cause extravasation of nearby fluids into the bursa, which stimulates the inflammatory response. This response occurs in two phases: The vascular phase, in which blood flow to the surrounding area increases, and the cellular phase, in which the leukocytes migrate from the blood to the affected area. Other possible causes include gout, sarcoidosis, CREST syndrome, diabetes mellitus, alcohol abuse, uremia, and chronic obstructive pulmonary disease. Some cases are idiopathic, although this may be due to trauma that patients do not remember.
The prepatellar bursa and the olecranon bursa are the two bursae most likely to become infected, or septic . Septic bursitis usually occurs when trauma to the knee causes abrasion, although it may also be caused by bacteria traveling through the blood from a pre-existing site of infection. In about 80% of septic cases, the infection is caused by Staphylococcus aureus ; Other common infections are Streptococcus, Mycobacterium and Brucella. It is very unusual for septic bursitis caused by anaerobic, fungal, or Gram-negative bacteria. In very rare cases, the infection can be caused by tuberculosis.
Diagnosis
There are several types of inflammation that can cause knee pain, including sprains, bursitis, and injuries to the meniscus. The diagnosis of prepatellar bursitis can be made on the basis of physical examination and the presence of risk factors in a person's medical history; swelling and pain in front of the knee, combined with a profession that requires frequent kneeling, suggests prepatellar bursitis. Swelling of multiple joints with limited range of motion may indicate arthritis instead.
Physical examination and medical history are generally insufficient to distinguish between infectious and noninfectious bursitis; aspiration of bursal fluid is often necessary for this, along with cell culture and Gram staining of the aspirated fluid. Septic prepatellar bursitis can be diagnosed if the fluid is found to have neutrophil count above 1500 per microliter, the threshold is significantly lower than septic arthritis (50,000 cells per microliter). Tuberculosis infection can be confirmed using a roentgenogram and urinalysis.
Prevention
It is possible to prevent the onset of prepatellar bursitis, or prevent symptoms from worsening, by avoiding trauma to the knee or often kneeling. Protective knee pads can also help prevent prepatellar bursitis for those who need professions often kneel and for athletes who play contact sports, such as American football, basketball, and wrestling.
Treatment
Non-septic prepatellar bursitis can be treated with rest, application of ice to the affected area, and anti-inflammatory drugs, especially ibuprofen. The height of the affected foot at rest can also speed up the recovery process. Severe cases may require fine-needle aspiration of the stock fluid, sometimes coupled with cortisone injections. However, some studies suggest that steroid injections may not be an effective treatment option. Once bursitis is treated, rehabilitative exercises can help improve joint mechanics and reduce chronic pain.
Opinions vary for which treatment options are most effective for septic prepatellar bursitis. McAfee and Smith recommend an oral antibiotic program, usually oxacillin sodium or cephradine, and assert that surgery and drainage are not necessary. Wilson-MacDonald argues that oral antibiotics are "inadequate", and recommend intravenous antibiotics to manage infections. Some authors suggest surgical irrigation of the bursa by means of subcutaneous tubes. Others suggest that bursectomy may be necessary for difficult cases; surgery is an outpatient procedure that can be done in less than half an hour.
Epidemiology
The various nicknames associated with prepatellar bursitis arise from the fact that it usually occurs among people whose professions need to kneel frequently, such as carpenters, carpet layers, gardeners, maids, mechanics, miners, plumbers, and roofers. The exact occurrence of this condition is unknown; it is difficult to estimate because only severe septic cases require inpatient care, and mild non-septic cases are generally not reported. Prepatellar bursitis is more common in men than women. It affects all age groups, but is more likely to be septic when it occurs in children.
References
Source of the article : Wikipedia
0 Comments