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Housemaids knee is also known as prepatellar bursitis as it was common among housemaids, due to the compression on their knees from kneeling on hard floors. There are over 150 bursa in the body. They protect our muscles, tendons, and skin from friction or pressure from bones and joints. The anatomy of a bursa is similar to a deflated balloon. They are a double membrane sacks that in their normal health state are flat. When inflamed they become fluid-filled and swollen.
The prepatellar bursa is in front of the knee cap, under the skin at the front of the knee. It protects the skin at the front of the knee from being damaged by the movement of the knee cap. When a bursa becomes inflamed, the condition is called bursitis. Therefore, prepatellar bursitis is an inflammation of the prepatellar bursa.
The most notable symptom is the swelling at the front of the knee. Which can be significant and is only located on top of the knee cap and does not spread. The front of the knee will look significantly raised, while the rest of the knee looks normal. Usually, there isn’t any bruising but the area may look red.
The knee can feel warm and tender to touch at the front or to kneel on. Generally, pain levels are not high and most people have low or no pain at rest, this is often described as an ache or tenderness. In moderate and severe cases, due to greater swelling, it will be painful to bend the knee.
The prepatellar bursa is commonly caused by excess pressure on the knee cap. Prepatellar bursitis can be acute, usually a result of trauma to the front of the knee, or chronic as a result of repeated compression and overuse. A third and less common form is infected or septic bursitis.
Housemaid’s knee is sometimes also referred to as Carpet layer’s knee or carpenter’s knee. As repeated kneeling is the most common cause of inflammation of the prepatellar bursa. Wrestling is a sport with a higher risk of developing bursitis. Prepatellar bursitis it is the most common knee injury for these athletes (Mysnyk et al, 1986).
There are 4 most common causes of developing prepatellar bursitis:
Treatment needs to address the causes of the bursitis. It will be necessary to stop or significantly reduce the activities that have contributed to it developing. This may include not kneeling or a rest from sport.
Regular application of ice, taking anti-inflammatory medication, raising the legs when resting, or having frequent massages are effective ways to manage pain and reduce the swelling in the bursa. Some forms of taping, stretching and light mobility exercise can also help with this.
In more severe cases draining the bursa may be necessary or antibiotic treatments may be necessary in cases that are infected. Septic bursitis was previously treated by removing the bursa but more research has shown that conservative treatments have better outcomes in these cases (Baumbach et al, 2014).
Strengthening exercises may be recommended by a physiotherapist if a contributing factor was weakness or a muscle strength imbalance.
Common physio exercises will include stretches for the quadriceps, hamstring, and calf muscles. As well as strengthening the posterior chain of muscles, including the glutes, hamstrings, and calves. Exercises such as bridges, clams, and hip abduction are a good way to build strength without aggravating symptoms.
In most cases recovery is straightforward if the advice of ice, medication, and rest is followed. These cases usually resolve within 2-4 weeks, and cause no further complications. It can be a longer recovery in more chronic cases, especially when kneeling is a necessary part of life for the individual.
It is very important to have bursitis assessed and that the signs of infection are monitored closely, including raised temperature, sweating, and chills. If an infection develops it must be treated quickly to ensure it is resolved. It is advised to go to the hospital as soon as possible. In severe cases, infection of the bursa can lead to sepsis and this can be life-threatening. So while in most cases a bursitis is not serious, if it becomes infected it can be dangerous.
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.