Housemaid’s Knee – also known as Prepatellar Bursitis

Housemaid’s knee or prepatellar bursitis is usually caused by the inflammation of the bursa (a small fluid-filled sac) in front of the patella (kneecap). It causes swelling and pain in the fluid-filled sac in front of the knee. This fluid-filled sac lies on top of the kneecap. Housemaid’s knee usually occurs in those who spend extended periods in repetitive kneeling, but it is generally more common in males (between the ages of 40 and 60) than in females.

What is a prepatellar bursa?

Around our knee joint, there are about four main bursae that include suprapatellar, infrapatellar, pes anserine, and prepatellar bursa. The prepatellar bursa is a small fluid-filled sac (bursa) that lies between the kneecap and the skin, prevents friction between bone and soft tissues, and protects the patella.

Too much pressure on the bursa irritates it, and its thin lining thickens and produces extra fluid in the bursa to protect the knee and cause its swelling. Though all of these bursae are susceptible to inflammation (bursitis), prepatellar bursa and olecranon bursa (in the elbow) are most frequently affected.

What is bursitis?

Bursitis refers to the inflammation within the bursa. As there are several bursae in our body, they are generally present around the joints and in the places where tendons and ligaments pass over the bones. The primary function of the bursa is to help lessen friction and allows a maximal range of motion around the joints, especially the knee joint.

Categories of prepatellar bursitis:

There can be many categories of bursitis; some of them are:

• Septic bursitis: Bursitis that is caused by the infection or inflammation that results in pain and swelling of the bursa is called septic bursitis.
• Aseptic bursitis: Bursitis that is not caused by the infection or inflammation but results in pain and swelling of the bursa is called aseptic bursitis.
• Acute prepatellar bursitis: Acute prepatellar bursitis results from sudden damage to the bursa in front of your kneecap as from trauma or infection.
• Chronic prepatellar bursitis: Chronic prepatellar bursitis occurs due to repeated overuse or pressure on the knee from frequent kneeling.

Risk factors of Housemaids’ knee and prepatellar bursitis:

The most common causes of Housemaids knee or prepatellar bursitis are:

• Frequent kneeling: Repeated or frequent kneeling is the most common cause of housemaids’ knees. Repetitive kneeling causes irritation and friction that puts pressure on the prepatellar bursa and causes prepatellar bursitis or housemaids’ knees.
• Sudden injury or fall: Acute trauma to the knee from a sudden force (hit) or a fall can cause housemaids’ knee.
• Repeated minor injuries to the knee: Repeated minor injuries usually occur when kneeling for extended periods and can cause housemaids’ knees. This typically happens after spending long periods kneeling and putting pressure on the kneecap.
• Infection or inflammation: A cut, scratch, or insect bite on the knee can cause the fluid in the prepatellar bursa to become infected and cause pain and inflammation in a bursa (bursitis). So this type of bursitis is also called infectious bursitis, that most commonly occurs from bacterial infection.
• Gout: if you’ve gout, you’re at more risk of developing housemaids’ knees. Gout is caused by the accumulation of small uric acid crystals in your body’s joint cavities that cause inflammation, pain, and joint swelling.
• Other inflammatory diseases: You’re at risk of developing housemaids’ knee or prepatellar bursitis if you already have any inflammatory disease like rheumatoid arthritis, which causes pain, inflammation, and swelling of the anterior knee joints. Housemaid’s knee can also be confused with ‘wear and tear’ arthritis (osteoarthritis).

Symptoms of housemaids’ knee and prepatellar bursitis:

Housemaid’s knee causes pain and swelling at the kneecap. Pain and swelling can be acute or chronic, depending upon the type of bursitis. You may have difficulty bending your knee and walking. Some people describe a sharp needle-like pain while kneeling.

Some of the common symptoms of housemaids’ knee are:

• Knee Pain, mainly when moving or bending the knee
• Swelling at the kneecap or patella
• Redness of the knee at the area of swelling
• The knee may feel slightly warm and tender to touch
• Limited movements in your knee, in case of severe prepatellar bursitis, you may not be able to move your knee normally
• If the bursitis is caused by infection, you may have a fever, or you can experience achiness and chills
• Tightness and stiffness with knee flexion due to swelling

The symptoms of a Baker’s cyst are also very similar, it includes pain in the back of the knee and calf.

Diagnosis of housemaid’s knee:

The doctor can diagnose a housemaid’s knee by simply examining your knee, or he can take your history about any recent infection, fall, or occupation. He can diagnose prepatellar bursitis by:

• Physical examination for signs and symptoms like checking for warmth, redness, or swelling around your knees.
• If your doctor suspects the infectious cause for the housemaid’s knee, he can draw fluid out of your bursa and send it for test running. An ultrasound scan is regarded as a gold standard imaging technique for assessing the presence of bursal pathology.
• Your doctor can also order tests like X-rays, imaging tests, MRI, or some lab tests.

Treatment of housemaids’ knee and prepatellar bursitis with medication:

The treatment options for housemaids’ knee or prepatellar bursitis largely depend on its leading cause. Some treatment options are:

• For non-infectious bursitis: Some anti-inflammatory drugs or NSAIDs like ibuprofen or aspirin can be taken to reduce inflammation or for mild to moderate pain caused by housemaids’ knees.
• For infectious bursitis: If a housemaid’s knee is caused by infection, your doctor may draw some fluid from your knee bursa and send it for tests. Antibiotic treatment can be started before the test results arrive, and after the test results, he’ll prescribe you precise medicines according to your test results. Also, it is important to wear a protective sleeve or knee padding to protect it from further friction. In rare cases, patients might need surgery to remove the bursa if all other treatments fail.
• Corticosteroid injections: If your inflammation doesn’t settle with simple treatments, your doctor can recommend a steroid injection (a cortisone shot) into your inflamed bursa to counter the inflammation. Anti-inflammatory medication can be of great help when you want immediate relief.
• Aspiration: in case of excessive swelling of the prepatellar bursa, the doctor can drain the fluid out of the bursa with a needle.
• Surgery: Sometimes, the inflamed bursa must be surgically removed when all the treatment has failed.

Prolotherapy

The prepatellar bursa has a poor blood supply, which is why it can struggle to heal on its own. It is the oxygen and nutrients in our blood supply that helps to heal the bursa.

Prolotherapy involves the injection a regenerative solution into the bursa to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the issue, it is deemed to be a permanent fix.

Lifestyle and home remedies for housemaids’ knee and prepatellar bursitis

You can treat your knee injury (if it is not severe) at home by taking these measures:

• Rest your knees: by resting, avoiding overuse, and discontinuing the movements that cause bursitis can relieve your pain
• Apply ice: Ice is considered an excellent natural treatment to help reduce the swelling and pain from housemaids’ knees. You can use ice packs on your knee for 20 minutes several times a day until the pain goes away.
• Stretching: stretching your tight muscles that are causing prepatellar bursitis can relieve the pressure on the prepatellar bursa, so it stops producing excess fluid and swelling.
• Physiotherapy: a physiotherapist can help you relieve your pain by teaching you some exercises if your knee joint is affected by a limited range of movement. So, physical therapy or exercises can support the muscles in the affected area to ease the pain.
• Assistive devices: Temporarily using a walking cane or another device can help relieve the pressure on the affected area.

Frequently Asked Questions

What is the treatment for housemaids’ knees?

The primary treatment plan for housemaid’s knee goes to reduce inflammation and the pain resulting from the inflammation. The fastest way to treat is using ice for at least 10 to 15 minutes. Other treatment strategies include:

• Using non-steroidal anti-inflammatory drugs like ibuprofen
• Avoiding knee exercises
• Applying compression
• Raising the knee

How long does it take for the housemaids’ knees to heal?

Housemaid’s knee does not take much time to heal if proper treatment is administered. The pain and swelling usually disappear somewhere around a month and a half, but during this time, some precautions must be followed, including retraining irritating exercises and stances and weight-bearing straightforwardly on the knee.

What does bursitis in your knee feel like?

Bursitis is an inflammatory condition, so the first thing you may feel is disabling pain and the ability to move. Usually, the impacted part of your knee could feel warm, delicate, and weak when you try to move or exert force. You might also notice swelling in the same area. A sharp movement of the knee can make side effects show up quickly. 

Is it OK to walk with knee bursitis?

A person with knee bursitis should try to lessen and avoid strenuous exercises as they might worsen the condition by aggravating the pain, but it is OK to walk with knee bursitis because it is tolerable and does not exert unnecessary pressure on the joint. Moreover, walking can increase the extent of movement on the knee joint and thus can hold it back from turning out to be excessively inelastic.

Can Squats cause knee bursitis?

Yes, the squats can cause knee bursitis because the meniscus cartilage has to bear a lot of pressure during deep squatting. With time, this exercise can cause wear and tear of the critical ligaments and cartilages of the knee. But if squats are done under professional care, they may enhance the health of your knee joints.

Can I exercise with the housemaids’ knee?

Yes, you may exercise with a housemaid’s knee, but not every exercise will benefit a housemaid’s knee. Some exercises may aggravate the pain and other symptoms, but others may help relieve the symptoms. Do delicate fortifying and extending exercises to treat knee bursitis. Heel slides, straight-leg raises, and quad sets are also great exercises.

References:

1. Tidy, D. C. (2020, June 28). Housemaid’s knee (prepatellar bursitis): Health. Patient.info. Retrieved April 3, 2022, from https://patient.info/
2. Doctor , S. (2022, February 12). House maids knee: What can you do about it? 
3. Foundation, W. (2021, March 30). Prepatellar bursitis. Wikipedia. Retrieved April 3, 2022, from https://en.wikipedia.org/wiki/
4. Injections, U. G. (2022, January 21). Prepatella bursitis (known as Housemaid’s knee) what is it? Ultrasound Guided Injections. Retrieved April 3, 2022, from