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The knee
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Andrew Price, Nick Bottomley, William Jackson
The swelling is below the patella and superficial to the patellar ligament, being more distally placed than prepatellar bursitis; it used to be said that one who prays kneels more uprightly than one who scrubs! Treatment is similar to that for prepatellar bursitis. Occasionally the bursa is affected in gout.
Knee disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
Any asymmetry including loss of the parapatellar groove indicates an effusion or haemarthrosis (Figure 7.1b). Severe swelling can be demonstrated by performing patellar tap – firm downward pressure on the patella to elicit palpable tap of a ballotable patella against the trochlea of the femur. This should not be mistaken for prepatellar bursitis, which is extra-articular, and the swelling lies directly over the patella (Figure 7.1c). In a more subtle knee swelling or effusion, the sweep test can be performed by placing a palm just proximal to the patella and with the other hand, ‘sweeping’ the medial side of the knee to empty the area of any fluid followed by a lateral pressure while observing for a bulge over the medial side indicating presence of effusion.
Intra-articular and local soft-tissue injections
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
Michael Shipley, Vanessa Morris
Prepatellar bursitis causes fluctuant swelling in front of the patella. Aspiration and injection of a corticosteroid helps if infection has been ruled out. The deep infrapatellar bursa lies between the patellar tendon and the tibia and is locally tender when inflamed.
Clinical and immunologic differences in cellulitis vs. pseudocellulitis
Published in Expert Review of Clinical Immunology, 2021
Michael Goldenberg, Henry Wang, Trent Walker, Benjamin H Kaffenberger
Bursitis is an inflammation of one or more bursae, fluid-filled synovial pouches that reduce friction between bones, tendons, and skin [107]. The most common cause is repeated microtrauma, but other etiologies include acute trauma or hemorrhage, septic bursitis, and inflammation from conditions like rheumatoid arthritis or gout. Bursitis can present with pain, erythema, decreased range of motion, and bursal enlargement, along with leukocytosis, fever, and warmth. Olecranon and prepatellar bursitis are the most common sites of repeated microtrauma bursitis, and they can become secondarily infected [107]. Bursal trauma increases local blood flow, allowing for migration of leukocytes and increasing synovial cell fluid production, thus establishing a proinflammatory environment [107a]. This environment can become colonized by bacteria via direct seeding, often associated with overlying soft tissue infections, and less commonly by hematogenous spread [107a]. Septic bursitis is most often caused by Staphylococcus aureus, responsible for up to 85% of cases [108a-112]. An ultrasound can differentiate bursitis from cellulitis, and bursal fluid aspirate analysis can distinguish septic bursitis from noninfectious causes, such as gout or pseudogout [108–111, 107a]. A microscopic exam of the bursal fluid is likely to show an inflammatory cocktail of interleukins, TNF-alpha, and cyclooxygenases [107a]. Treatment depends on the type of bursitis, with compression, analgesics, and ice being used for noninflammatory causes, antibiotics used for septic bursitis, and management of the underlying condition for inflammatory causes of bursitis [107].
Morel-Lavallée lesions (internal degloving injuries) of the lower extremity in the pediatric and adolescent population
Published in The Physician and Sportsmedicine, 2021
Indranil Kushare, Ramesh Babu Ghanta, Nicole A. Wunderlich
Diagnosis and imaging should be based on a high index of clinical suspicion, a thorough clinical examination which can be confirmed with radiologic imaging [9]. The hallmark physical examination finding of MLL of the knee is a large suprapatellar area of palpable fluctuance, often extending to the midthigh medially and laterally [11,16]. To distinguish the MLL of the knee from prepatellar bursitis and quadriceps contusion, taking a careful history and performing a thorough examination is essential [11,13,22] which is also needed to rule out any associated injuries which might need treatment for associated injuries as seen for a few patients in our cohort.
Dosing of intra-articular triamcinolone hexacetonide for knee synovitis in chronic polyarthritis: a randomized controlled study
Published in Scandinavian Journal of Rheumatology, 2019
During the observation period, three participants had contact with our departments for pain in the treated knee without clinical signs of arthritis. Anserine bursitis was diagnosed in two cases and prepatellar bursitis in one case.