Pre Patellar Bursitis
Prepatellar bursitis is also called housemaid’s knee or carpenter’s knee characterised by inflammation of the bursa. It happens when your bursa is frequently irritated, damaged or infected and makes too much fluid. The extra fluid causes your bursa to swell and puts pressure on other parts of your knee. The stress of weight-bearing and traumatic impacts on the knees during wrestling activities makes wrestlers especially prone to this.
Prepatellar bursitis is more common in the lighter weight classes. Because the lighter weights spend more time shooting at their opponent’s leg compared to the upper weights where throws and other moves not involving knee contact to mat are more common.
What is A Bursa?
A bursa is a fluid-filled sac which ensures there is less friction between body parts. The prepatellar bursa is located superficially between the skin and the patella. The subcutaneous prepatellar bursa of the knee facilitates the movement between the patella and overlying skin.
In the general population, bursitis is felt to be due either to acute trauma from a single blow or from chronic irritation. The chronic irritation typically occurs in an occupation requiring excessive kneeling.
Causes-
- Direct blow to the anterior part of the knee – A direct blow to the anterior aspect of the knee during takedown is the main cause
- Constant friction between the skin and patella which is more commonly occurs in wrestlers
- Due to frequent fall on knee
- Due to pre existing medical conditions like Gout, Rheumatoid arthritis
- Bacterial Infection (commonly by S. Aureus) – It causes septic bursitis. Previous trauma is a predisposing factor in the development of this.
Most prepatellar bursitis cases occurred insidiously, but direct impact during takedown maneuver is suspected as being the most frequent cause.
Clinical Presentation-
- PAIN – Due to chronic kneeling wrestlers may experience pain. There may be tenderness or aching at the time of resting. Some don’t feel any rest pain but feel aching pain when they bend or kneel.
- SWELLING – There is marked swelling at the front of the knee. You’ll be able to “see” and feel your swollen bursa sac through your skin. It usually feels “squishy” when you press on it.
- LIMITED RANGE OF MOTION – There is painful limitations of range of motion in severe case of prepatellar bursitis. In mild case there may not be any limitation in range.
In case of Bacterial Infection, they’ll experience additional symptoms and signs like fever, achiness, chills and reddish discolouration of knee.
How wrestlers prevent prepatellar bursitis??
- Use Knee pads: Wearing kneepads can help cushion your knee and prevent too much pressure on your bursa.
- Avoid infections: If you have a cut or insect bite on your knee, be sure to keep it clean to avoid getting an infection that could spread to your bursa.
- Apply ice and elevate your knees after exercising: As wrestling involved frequent kneeling or squatting, apply ice to your knees and elevate your legs afterward.
The prognosis appeared better if the wrestler had no previous history of bursitis.
Management
Acute Bursitis
Acute prepatellar bursitis happens when there’s sudden damage to your bursa in front of your kneecap. This usually happens from trauma (such as a forceful impact to your knee) or an infection.
- Avoid activities those worsens symptoms.
- Acute bursitis can be managed by rest, ice, compression, elevation and anti-inflammatory drugs.
- Painful bursa not responding to conservative management requires aspiration followed by compression.
- Knee ROM and static Quad exercises can be done after 48-72 hours. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and knee joint.
Therapeutic exercises to strengthen and stretch the muscles of the knee. This includes static contraction of the quadriceps. This should be an exercise that the patient can do at home 1 to 3 times a day. To see if the exercise is working you have to put your fingers on the inner side of the quadriceps, you will feel the muscle tighten during the contraction of the muscle.
Low-impact Exercise –
Such as cycling or using the elliptical machine, is a good option.
Quadriceps stretching
is required for the patient, it helps in reducing friction between the skin and the patella tendon. There is less friction when the patella tendon is more flexible.
After the initial treatment the wrestler can return to sport with a knee pad. If reoccurrence, the same procedure is repeated often increasing the rest period.
Surgery with the second reoccurrence appears to provide the best means of getting the highly motivated athlete back in action as soon as possible. When there is no urgency in returning to action, conservative treatment should be given a longer trial.
Chronic Bursitis –
Chronic bursitis usually happens from repeated overuse or pressure to your knee, such as frequent kneeling as in wrestlers. It is associated with a thickened bursa wall detectable on physical examination even when the bursa was not fluid filled.
1. Short Wave Diathermy: short wave diathermy is a deep heating modality that uses heat to provide pain relief, it improves the blood supply to targeted muscle, removal of waste products.
2. Tens : transcutaneous electrical nerve stimulation is an electrical modality that provides pain relief by providing pain modulation. TENS closes the gate mechanism at the anterior grey horn in the spinal cord. Also stimulates the endogenous opioid system which prevents the release of substance p at the anterior grey horn.
3. Straight leg raises: Sit flat on the floor with the legs straight out in front of you. Raise one leg off the floor keeping the knee straight. Hold for 3 to 5 seconds before lowering back to the ground. Repeat 10 to 20 times. This exercise can be done daily. Progress the exercise by increasing the length of hold and the number of reps.
4. Strengthening exercises and stretching: when the pain has reduced sufficiently, strengthening and stretching exercises can begin and these can then be built up gradually. The most effective form of muscle training in cases of tendon problems is eccentric training because the collagen fibers will be set in the right/functional direction.
For the popliteus, eccentric strengthening (closed kinetic chain) of the quadriceps is effective to reduce strain on the popliteus.
Quad eccentric exercise 1- Start by standing with feet right next to each other, level the hips by holding it. Then try to touch the heel not stomp down with this heel and then come back up.
Quad eccentric exercise 2 – Go on your knees, try to pull the ribs down, bring pelvic up and then nice straight line all the way down.
