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FPT Bursitis (pes anserine bursitis/pre-patellar bursitis)

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x Bursitis of the Knee JB.docx  

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Bursitis of the Knee

 

Description

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Figure 1: The areas of the pre-patellar (red), infra-patellar (purple) and pes anserine (yellow) bursas are shown

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The prepatellar bursa is located superficial to the patella.  It decreases friction as the soft tissues glide over the patella during knee flexion and extension. Because of the location of the prepatellar bursa, it is susceptible to repetitive microtrauma, especially when kneeling. Its location also makes it susceptible to blunt and penetrating trauma. Septic prepatellar bursitis can occur following local inoculation due to trauma. The prepatellar bursa has three layers. The subcutaneous layer is located just below the deep dermis and is the one most commonly implicated.

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Figure 2: A clinical photograph of knee bursitis with a skin abrasion and erythema. (from https://upload.wikimedia.org/wikipedia/commons/e/e1/Bursitispraepatellaris.jpg)

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Chronic prepatellar bursitis can present with a soft, non-tender boggy mass on the anterior aspect of the patella, while acute bursitis can present as an erythematous, warm and tender mass. Patients with infrapatellar bursitis exhibit tenderness over the patella ligament, and local edema. Strength and range of motion are often unaffected but may be limited secondary to pain.

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Figure 3: An MRI of the knee, illustrating pre-patellar bursitis (red arrow). (modified from https://radiopaedia.org/articles/prepatellar-bursitis?lang=us)

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Musculoskeletal ultrasound is emerging as a viable imaging modality to assess the knee joint.  Advantages include its ease of availability, economic savings compared to MRI, ability to easily compare abnormalities to the contralateral side, demonstration of fibrillar microanatomy of tendons, ligaments, and muscles, and the ability to compress and dynamically assess structures. Musculoskeletal ultrasound can be utilized to distinguish difficult cases of joint effusion from that of bursal swelling.  

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Risk Factors and Prevention

Valgus knee deformity, obesity, diabetes, and female sex are risk factors for pes anserine bursitis. The risk for pes anserine bursitis can be decreased by stretching the hamstring muscles as well as strengthening the quadriceps and secondary knee stabilizing muscles. Maintenance of a healthy weight can also decrease the risk of pes anserine bursitis.

 

Blue collar employment, significant kneeling, and male sex are risk factors for prepatellar and infrapatellar bursitis. The risk of prepatellar and infrapatellar bursitis can be reduced by the use of knee pads when kneeling for an extended period of time and activity modification when possible.

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