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