suprapatellar bursitis

Last edited 04/2018 and last reviewed 02/2023

Suprapatellar bursitis occurs above the patella

• suprapatellar bursa extends superiorly from beneath the patella under the quadriceps muscle
  • vulnerable to injury from both acute trauma and repeated microtrauma
    • acute injuries are from direct trauma to the bursa via falls directly onto the knee
    • microtrauma may occur from overuse injuries, or from jobs that result in repeated pressure on the knees, such as carpet laying
  • infection may result in suprapatellar bursitis

Factors that can contribute to knee bursitis include:

• direct trauma or blow to the knee
• frequent falls on the knee
• repeated pressure on the knee (eg from activities that entail prolonged periods of kneeling) or repetitive minor trauma to the knee
• arthritis of the knee can be associated wth bursitis e.g. gout, rheumatoid arthritis, and osteoarthritis.

Clinical features include:

• suprapetallar swelling - may be clinically difficult to differentiate from prepatellar swelling
• may be limited motion of the knee
• erythema and warmth may occur in septic bursitis and secondary to gout
• knee pain may be present
• in bursitis swelling is within the bursa, not the knee joint
  • is an important difference between fluid accumulation within the bursa and within the knee joint
  • symptoms of knee bursitis are generally aggravated by kneeling, crouching, repetitive bending or squatting and symptoms can be relieved when sitting still

Diagnosis:

• often clinically
• an MRI or Ultrasound are the most effective for a definitive diagnosis
• blood tests e.g. FBC, CRP, uric acid - may help identify other aetiological factors

Management:

• management depends on whether septic or non-septic bursitis
  
  
• conservative management - general measures
  • rest, ice, and reduced activity
  • consider analgesia such as paracetamol or a nonsteroidal anti-inflammatory drug such as ibuprofen
  • avoid trauma to the knees - however if this is not possible, suggest protective knee pads

Non-septic bursitis

• medical treatment
  • aspiration of the bursa and injection of a corticosteroid - only indicated if non-septic bursitis
    
    
• surgical treatment
  • may be indicated if chronic or recurrent
  • surgical options include:
    • arthroscopic bursectomy
    • open bursectomy

Septic bursitis

• septic bursitis is usually successfully managed non-operatively with rest, compression, immobilisation, aspiration and antibiotics (1)
• if septic bursitis is suspected:
• treat empirically with an oral antibiotic that covers staphylococcal and streptococcal species until culture results are known
  • adult doses
    • flucloxacillin (500 mg four times a day) is the preferred antibiotic. Erythromycin (500 mg four times a day) may be used if the person is allergic to penicillin, or clarithromycin (500 mg twice a day) if erythromycin is poorly tolerated
• if patient is immunocompromised people then seek specialist advice
• incision and drainage of the bursa may be indicated if there has not been significant improvement in the condition after 36-48 hours
• regular review is required to guide management