Housemaids Knee (also known as Prepatellar Bursitis)
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Housemaids knee is a condition of swelling, heat and pain at the front of the knee. It is characterised by a local pocket of swelling on top of the knee cap. It is common with people who kneel frequently, such that it is sometimes called carpet layers knee or clergyman’s knee. While kneeling is a common cause it can also occur from a trauma to the front of the knee, such as a fall landing on the knee cap. Additionally, it can occur if the skin is broken by a cut or puncture, such as from an insect bite or sting.
Bursitis is diagnosed by clinic assessment by a medical professional. However, prepatellar bursitis does present quite clearly, with no pain in the joint but a painful, hot lump of soft swelling on top of the knee cap. The history of the development of this injury is also related to impact or pressure on the knee cap, or a cut or puncture to the skin on the knee cap. In the absence of a history of this kind, it may not be a likely diagnosis.
If you are unsure about your diagnosis it is best to have an assessment with a medical professional such as a doctor or physical therapist.
Housemaids knee has a distinct presentation. It looks swollen and inflamed, with the swelling localised on the front of the knee cap. This prominence of swelling on the knee cap will often be soft and flexible to touch. In most cases the skin will be red and it will feel warm or hot. The rest of the knee will be free from swelling, so it will not look puffy, it will just have the specific swelling prominence at the front.
Most of the time bursitis will resolve on its own, but it depends on the cause. A one off fall with a landing directly onto the knee cap may cause a bursitis. In most cases this will resolve without intervention, over a few weeks. However, it will need more intervention if it has developed from a repetitive stress and irritation to the bursa from prolonged kneeling, for example for a carpet layer who is kneeling most days.
If left untreated bursitis usually resolves without additional medical help. There are a few scenarios where it does not resolve and may need input from a physical therapist or medical doctor.
With bursitis, an infection can occur if the skin has been broken, such as with a cut from a fall or a puncture wound from an insect sting. If the bursa becomes infected this is serious and will need medical attention. This may be in the form of aspiration of the fluid within the bursa and medication to treat the infection. If the infection is not treated it can lead to widespread infection in the body and sepsis which can be life-threatening.
If the bursa isn’t infected but the swelling doesn’t resolve or continues to frequently recure then a physical therapist will be able to help. They will be able to discuss your case of bursitis and investigate the reasons for the issue persisting. Whether there is a biomechanical reason or if the issue is frequent kneeling for work or a hobby they are well placed to offer you advice to help.
With bursitis of the knee, the joint is healthy, uninjured and not inflamed. Therefore, activities such as walking should not affect it greatly. Walking, like any gentle exercise, will increase the heart rate and blood circulation which can be beneficial for tissue healing, such as recovery of bursitis. Cycling is also a good option. Blood is the transport system for our body to get factors for healing to where they are needed, such as white blood cells to help fight infection. Therefore gentle exercise can be beneficial for recovery.
The triggers for bursitis are all activities that cause the bursa to become inflamed. Common triggers of bursitis include: acute impact to the knee cap, repetitive load to the knee cap such as kneeling or crawling, a cut or abrasion to the front of the knee or an insect sting or bite that breaks the skin.
It is common with athletes such as wrestlers, with occupations such as carpet layers and gardeners, or with individuals who have fallen and landed directly onto their knee cap.
Bursitis does not affect the joint, it is the swelling of a small pocket outside of the main joint. Therefore structural braces to help with stability of the joint do not often help with symptom relief or improving recovery. Additionally having pressure on the swelling can be more painful than leaving it uncovered.
For those who experience pain at the front of their knees from habitual kneeling, even if a bursitis has not yet developed, it can be useful to use some cushioned knee pads or some form of padding to kneel on. There is a wide variety of knee pads on the market, some attached directly onto your leg and may have gel filled sections to provide additional protection from the prepatellar bursa. Others, are made of various types of foam and are to be knelt on.
The fastest way to cure bursitis is by resting the affected knee, applying ice and taking anti-inflammatory medication. In addition to these remedies, the application of a compression bandage or garment and elevation of the leg can help reduce swelling.
Typically knee bursitis will last for 2-4 weeks if the cause was acute and there are not factors that are maintaining the inflammation. These factors are similar to the triggers of bursitis, like kneeling or crawling. In some individuals with medical conditions that have reduced tissue healing times or increased risk of infection, it may take longer to fully recover.
This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.