Deep & Superficial Infrapatellar Bursitis: Symptoms & Treatment

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  • 0:04 Intrapatellar Bursitis
  • 1:10 Symptoms
  • 2:36 Treatment
  • 4:05 Lesson Summary
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Lesson Transcript
Instructor: Anna Monroe

Anna is an emergency medicine and sports medicine physician.

Infrapatellar bursitis is a painful inflammation of the knee that can affect anyone, not just athletes or people with highly active lifestyles. In this lesson, we'll examine the different types of infrapatellar bursitis, their symptoms, and how each is treated.

Infrapatellar Bursitis

Julian recently began a new job installing hardwood floors, and he spends much of his workday kneeling on hard surfaces. This morning he awoke to a painful, swollen right knee. He could walk, but bending his knee to go up and down the stairs was excruciating. He sighed and reached for the phone to call his doctor.

After a visit, she determined that he had infrapatellar bursitis. Infrapatellar bursitis refers to swelling of the bursa below the patella. A bursa is a small fluid-filled pouch whose function is to help a tendon glide better. Bursae are found sandwiched between bones and tendons in locations all over the body. Typically they don't contain much fluid and are not really noticeable. However, if they become inflamed through injury, overuse, or infection, they can swell and cause pain.

The infrapatellar bursa is located beneath the knee cap, and it has two parts: superficial and deep. The superficial infrapatellar bursa is found on top of the patellar tendon, and the deep infrapatellar bursa is found below the patellar tendon. Even though there is an anatomic distinction between the two, clinically it's hard to tell the difference.

Infrapatellar Bursae and Surrounding Anatomy

Symptoms

Symptoms of infrapatellar bursitis include pain, swelling, limited movement in the knee, and tenderness of the skin in the affected area. Let's get back to Julian's knee. He also noticed a squishy and tender pouch of fluid beneath the skin right where he hurts. Julian does not notice any redness, so he most likely does not have an infection. However, in cases of an infection of the bursa, or septic bursitis, there can be redness of the skin overlying the bursa. Sometimes cases of septic bursitis follow a cut or other injury to the skin, so patients will sometimes notice an old wound or abrasion on the skin.

Because the bursa has swollen with fluid, either blood (in the case of an injury) or pus (in the case of an infection), it does not serve its purpose as a friction reducer during joint movement. Instead, this painful balloon creates discomfort with joint use, especially when bending or flexing the knee. Just like Julian noticed, walking can be painful. Again, it's really hard to tell whether the infrapatellar bursitis is superficial or deep, and it doesn't really change the course of treatment.

However, infrapatellar bursitis does not usually cause quite as much pain as conditions involving the knee joint itself. Conditions like an infection of the knee joint, or septic arthritis, create deeper pain and more diffuse swelling around the knee. Often an infection of the knee joint is more serious than infectious bursitis, so it's important to rule septic arthritis out as a cause of knee pain and swelling.

Treatment

The treatment of infrapatellar bursitis depends on its severity and source. Mild cases of non-infectious bursitis often do well with rest, ice, and limiting activities like bending and kneeling. In more severe or prolonged cases, it might be necessary to aspirate the bursa, or draw fluid from it. Sometimes corticosteroid medication is then injected into the bursa to calm things down. After an aspiration, the knee is often wrapped in a tight elastic bandage and immobilized for a short time in a brace. That's how Julian's knee was treated, and after a few days he felt ready to return to work.

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