GPAtlas🧭 When to suspect
Pre-patellar bursitis is inflammation of the pre-patellar bursa, the superficial fluid-filled sac lying between the skin and the patella on the anterior aspect of the knee. It presents as a well-defined, often fluctuant swelling directly over the kneecap. The classic association is repetitive or prolonged kneeling – historically "housemaid's knee" – and it is also seen after a single direct blow to the front of the knee. The infrapatellar bursa may be similarly affected (traditionally "clergyman's knee") and is managed identically.
Two questions decide management. First, is this a bursitis at all, or the far more serious septic arthritis of the knee joint itself? Second, if it is bursitis, is it septic (infected) or aseptic (non-infected)? Around one in three acute cases is septic, usually following a breach in the overlying skin, with Staphylococcus aureus the commonest organism.
Raise suspicion of a septic cause where there is a skin breach over the bursa, marked pain, spreading erythema, fever, or risk factors such as diabetes or immunosuppression.
| Feature | Aseptic (non-septic) bursitis | Septic bursitis |
|---|---|---|
| Typical trigger | Repetitive kneeling or a single direct blow | Often a graze, cut or puncture over the bursa |
| Pain | Mild to moderate, localised | Marked, often severe |
| Overlying skin | May be mildly warm and red | Hot, with spreading erythema (cellulitis) |
| Systemic upset | Absent | Fever, malaise, may be unwell |
| Key risk factors | Kneeling occupations, gout, rheumatoid arthritis | Skin breach, diabetes, immunosuppression |
| Action | Conservative management | Aspirate and start empirical antibiotics; admit if unwell |
Source: Primary Care Rheumatology Society · NICE NG141
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.