UMEM Educational Pearls

Title: What's the Diagnosis? Image by Dr. Kami Hu

Posted: 3/14/2014 by Haney Mallemat, MD
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Question

35 year-old carpet-layer presents with swelling of the superior portion of his knee that has progressively gotten worse over one week. He has no fever and has full range of motion (although pain is worse with movement). The knee is not tender to touch and the area is not erythematous or warm. What's the diagnosis?

Answer

Answer: Pre-patellar bursitis

The pre-patellar bursa is a superficial and synovial-lined space that reduces friction at the knee, separating the patella from the skin and the patellar tendon.
Inflammation to the bursa occurs secondary to direct knee trauma (either acute or chronic) and is typically benign.
It is associated with occupations that have a high incidence of trauma to the knee or repeated kneeling; hence the condition’s many names (carpet-layer's knee, coal-miner's knee, housemaid's knee, nun's knee)
Caution must be taken not to miss patients with septic bursitis (e.g., bacterial), especially in immunocompromised patients. If septic bursitis is suspected, fluid should be aspirated from the bursa and sent for analysis
Treatment for non-septic bursitis includes rest, (i.e., reduce trauma), NSAIDs, and physical therapy. If it remains persistent, incision and drainage by a qualified clinicians may be performed.

References

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