Infrapatellar fat pad knee pain hoffas syndrome clinical treatment dr mandell duration. Infrapatellar bursitis radiology reference article. Children with juvenile idiopathic arthritis jia may infrequently present with localized anterior knee pain or swelling, in addition to generalize knee pain induced by jia. Computed tomography scan ct or cat scan is a noninvasive diagnostic imaging procedure that uses a combination of special xray equipment and sophisticated computer technology to produce crosssectional images often called slices, both horizontally and vertically, of the body. Deepseated bursae are depicted on magnetic resonance imaging mri or computed tomography ct. Mr imaging can reveal a typical appearance for infrapatellar plica injury. This article shows the mr imaging appearance of injury to the infrapatellar plica. A case of bilateral deep infrapatellar bursitis is reported in a 19yearold man suffering from juvenile ankylosing spondylitis and surgically treated for bilateral tibial tuberosity enthesopathy.
Infrapatellar bursitis, also known as clergymans knee occurs due to the swelling and inflammation of the infrapatellar bursa located just below the kneecap patella. May 02, 2011 bursitis can clinically be misdiagnosed as joint, tendon or musclerelated pain. It occurs when one of the infrapatellar bursa becomes inflamed, either due to repetitive strain or from a direct impact. Repeated stress injury to the bursa and tendon from jumping, which can also cause tendonitis and infrapatellar bursitis. Infrapatellar bursitis symptoms, causes and treatment. Jul 05, 2019 a bursa is a small sac containing fluid which is responsible for lubrication during movement between bone and tendons.
Infrapatellar bursitis is inflammation of the bursa under your kneecap near the main tendon. In contrast to edema, bursitis appears as a localized fluid collection with welldefined borders 7. The prepatellar bursa lies just above the kneecap between the skin and the kneecap. A bursa is a small fluidfilled pouch whose function is to help a tendon glide better. The mechanism of injury influences which bursa is affected, with the most common ones being the. Once the initial inflammation has reduced a program of stretching and light. Knowledge regarding its anatomic location can aid the clinician in establishing a proper diagnosis. A 69yearold patient presented with chronic bilateral knee pain. A bursa is a sac that is closed, and filled with fluid. Statistical analyses were performed using spss for windows software ver 15. Prepatellar bursitis is inflammation and fluid collection within the prepatellar bursa, located between the patella and the overlying subcutaneous tissue. The fluid should be sent for analysis, since the prepatellar bursa is commonly a site of infection. Magnetic resonance imaging, or mri, uses a magnet to examine the inside of your body, useful for diagnosing conditions like bursitis.
Apr 18, 2015 superficial bursitis, as well as prepatellar, infrapatellar, medial collateral ligament, anserine, iliotibial tract, lateral collateral ligamentbiceps femoris bursitis, often occurs as a result of overuse and may be caused by occupational or everyday activities. Periarticular lesions detected on magnetic resonance imaging. Assessment of anterior subcutaneous hypersignal on proton. When a bursa gets inflamed, it swells, develops friction and starts irritating the muscle tendon it is supposed to protect. In cadaveric studies, a trilaminar prepatellar bursa was found in 7893% of people, and a bilaminar bursa was found in 722% cases. Mostly, it is an occupational disease that occurs in athletes, runners and. Bursitis can clinically be misdiagnosed as joint, tendon.
When assessing joints with various imaging modalities, it is important to focus on the extraarticular soft tissues that may clinically mimic joint pathology. If you suspect that you have infrapatellar bursitis then it is important to visit a qualified medical professional in order to rule out any other possible causes prior to considering any advice or treatment option. Knee bursitis infrapatellar bursitis classic youtube. Normally, it does not communicate with the joint space and contains a minimal amount of fluid. Apr 05, 2020 there are two infrapatellar bursas located above and below the tendon beneath the kneecap. Bursitis can be rapid in onset acute or build up slowly over time chronic. He noticed some discomfort when swimming and felt a pull in the anterior aspect of the left knee. Complications from rheumatoid arthritis, osteoarthritis or gout. Infrapatellar medical definition merriamwebster medical. Knee bursitis symptoms and treatment septic and prepatellar. Injury to the infrapatellar plica is uncommon but should be considered as a potential source of knee pain, especially if no other evidence indicates internal derangement.
The bursae are fluidfilled sacs around joints and tendons, which decrease friction from movement and provide a cushion between bones, tendons, muscles, and skin. According to one study, patients with septic bursitis usually presented earlier and had more pain, erythema, warmth and tenderness, and some had mild fever 37. Fifty cadaveric knees were dissected, and the deep infrapatellar bursa had a consistent anatomic location in all specimens. The inflammation may be acute or chronic, in the later case calcification may be apparent on plain radiographs. Infrapatellar bursitis definition of infrapatellar. The bursae most commonly subjected to inflammation are the prepatellar bursa, infrapatellar bursa, pes anserinus bursa and suprapatellar bursa. To help rule out injuries that can cause signs and symptoms similar to those of bursitis, your doctor might request one or more of. Computed tomography ct scan and magnetic resonance imaging mri complex fluid collection anterior to knee in region of prepatellar bursa. In addition to erosive nonspecific bone remodelling the excised specimens showed, in the bursa, synovial layer hyperplasia with mild subintimal inflammatory cell. One such example is that of pes anserine pain syndrome paps, which was formerly referred to as anserine bursitis. A bursa is a small sac containing fluid which is responsible for lubrication during movement between bone and tendons. Localized swelling over the patella, which may be tender, red andor warm. Infrapatellar bursitis definition of infrapatellar bursitis. An mri is needed to clarify damage caused to other regions of the medial side of the knee.
Prepatellar bursitis is an inflammation of the bursa in the front of the kneecap patella. Inflammation of an infrapatellar bursa is well detected on either targeted musculoskeletal ultrasound or on mri. The anatomy of the deep infrapatellar bursa of the knee. Bursae around the knee joints chatra ps indian j radiol. Infrapatellar bursitis or clergymans knee occurs with inflammation of bursae around the insertion of the distal patellar tendon. In this context, inflammation refers to bursal swelling with or without tenderness, redness, compression of neighboring structures, or documented rupture. Less common locations are the superficial infrapatellar and subcutaneous superficial calcaneal bursae. Bursae around the knee joints chatra ps indian j radiol imaging. Pdf deep infrapatellar bursitis in children with juvenile. It has been historically referred to as housemaids knee. An mri does not use radiation xrays and is a noninvasive medical test or examination.
Infrapatellar bursitis or clergyman knee occurs with inflammation of bursae around the insertion of the distal patellar tendon. In addition to erosive nonspecific bone remodelling the excised specimens showed, in the bursa, synovial layer hyperplasia with mild subintimal inflammatory cell infiltration, i. However, it can help in some situations, such as when other problems need to be ruled out for example, a tear in the cartilage or ligament. Ultrasound features of the deep infrapatellar bursa. Infrapatellar bursitis is a painful inflammation of the knee that can affect anyone, not just athletes or people with highly active lifestyles. Assessment of anterior subcutaneous hypersignal on protondensity. Deep infrapatellar bursitis stuart wildman, extended scope physiotherapist and msk sonographer this patient presented with chronic left knee pain, which had become recurrently painful over the past year. Infrapatellar bursitis natural treatment osmo patch us. Symptoms may include knee pain, swelling, and redness just below the kneecap. Disorders of the deep infrapatellar bursa are important to include in the differential diagnosis of anterior knee pain.
Bursae around the knee can be grouped as those that occur around the patella and those that occur elsewhere. The bursa is a smooth surface that helps to reduce friction between the bodys tissues, and the largest bursae plural for bursa are located in the shoulders, hips, elbows and knees. Infrapatellar bursitis also known as clergymans knee, is the inflammation of the infrapatellar bursa around the insertion of the distal patellar tendon, which is located just below the kneecap. The term bursitis should only be used to describe inflammation of bursae. However, analysis of fluid aspirated from the bursa is important in differentiating septic bursitis sb from nonseptic bursitis nsb. Nov 06, 2018 laboratory studies are not usually indicated to diagnose prepatellar bursitis. Bilateral deep infrapatellar bursitis associated with tibial. The simplest explanation of bursitis is to begin at the beginning. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. Infrapatellar bursitis clergymans knee is the inflammation of the infrapatellar bursa located just below the kneecap. Superficial bursitis most often occurs in the olecranon and prepatellar bursae. A bursa is a small sack of fluid, used to aid movement in joints. Which physical findings are characteristic of infrapatellar bursitis. Knee bursitis can cause pain above, on or below your patella kneecap.
Clinically, bursitis mimics several peripheral joint and muscle abnormalities. Septic infection of the bursal sac with microorganisms usually bacteria. When considering management, separate into septic and nonseptic bursitis. Infrapatellar bursitis infrapatellar bursitis, also known as clergymans knee occurs due to the swelling and inflammation of the infrapatellar bursa located just below the kneecap patella.
Constant pressure on the infrapatellar bursa from kneeling. Deep infrapatellar bursitis in children with juvenile idiopathic arthritis article pdf available in clinical rheumatology 302. Infrapatellar bursitis is inflammation of the superficial or deep infrapatellar bursa. Septic bursitis usually occurs as a result of penetrating trauma due to. Infrapatellar bursitis natural treatment osmo patch au. Bursitis is inflammation of a bursa, a synovial membranelined space, present overlying a number of joints. Introduction definedescribe the condition anatomy describe the pertinent anatomy pathogenesis describe the biomechanicsbiologic basis of the disorder or the mechanism of injury natural history describe the natural history, epidemiology and prognosis cli. The information on this page is intended for individuals who have been medically diagnosed with infrapatellar bursitis. Bursitis is an inflammation or irritation of the bursae plural of bursa. They may be useful, however, to identify osteoarthritis which may be a risk factor for pes anserine bursitis, and to distinguish from other autoimmune inflammatory conditions.
Aug 24, 2016 the management of prepatellar bursitis depends on its aetiology. Presumed prepatellar fibrosis in collegiate wrestlers. Ultrasonography is useful for further imaging of the bursa when the diagnosis. A magnetic resonance rezohnans imaging scan is usually called an mri. Infrapatellar bursitis information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. This way the bursa and muscle tendon get more and more irritated. This patient presented with chronic left knee pain, which had become recurrently painful over the past year.
Complications of septic prepatellar bursitis include septic arthritis, skin infection and necrosis, osteomyelitis, and sepsis. Infrapatellar bursitis is inflammation of the infrapatellar bursa at the front of the knee. Superficial bursae eg, olecranon and prepatellar bursae are. Bilateral deep infrapatellar bursitis associated with. Nov 11, 2015 knee bursitis infrapatellar bursitis classic. Aug 30, 2017 bursitis in the knee occurs mostly from overuse injuries and is less frequent due to trauma. Prepatellar and infrapatellar bursitis the prepatellar bursa is located in front. On mri, the bursa is seen as a high t2 fluidfilled structure. Prepatellar bursitis should be suspected if there is.
Infrapatellar bursitis is a condition that causes pain and swelling below the kneecap. Common superficial bursitis american family physician. It accounts for one of the 4 common forms of bursitis that a person may develop around the front of the knee. The prepatellar bursa is a superficial bursa with a thin synovial lining located between the skin and the patella. Nov 06, 2018 computed tomography ct scanning and magnetic resonance imaging mri are reserved for cases that have been difficult to manage eg, failure of initial treatment for septic prepatellar bursitis. Described findings are consistent with infrapatellar bursitis also called clergymans knee. They are known as the deep infrapatellar bursa, found beneath the patella tendon, and the superficial infrapatellar bursa, located above the tendon. Bursitis of the knee and hip musculoskeletal medicine for. Plain xrays of the knee are not necessary to make the diagnosis of prepatellar bursitis, infrapatellar bursitis, or anserine bursitis.
Infrapatellar bursitis may be a component of osgoodschlatter disease. Thinwalled bursa distended with hypoechoic fluid, peribursal hyperemia chronic bursitis. Here we explain the symptoms, causes, and treatment. Magnetic resonance imaging mri for bursitis stanford.
Injury is often due to leaning on hard surfaces or sudden impact. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. Imaging such as xray, magnetic resonance imaging mri, or ultrasound is not usually needed to diagnose bursitis. Some cases of bursitis are associated with certain occupations and are named accordingly. Feb 15, 2017 superficial bursitis most often occurs in the olecranon and prepatellar bursae. Infrapatellar bursitis refers to swelling of the bursa below the patella. We report five cases of deep infrapatellar bursitis in children with jia.
Deep infrapatellar bursitis stuart wildman, extended scope physiotherapist and msk sonographer. Prepatellar bursitis is also called housemaids knee or carpenters knee. Thickening of bursal wall, more mature synovial proliferation, more echogenic content. Infrapatellar fat pad knee pain hoffas syndrome clinical treatment dr mandell.
Ct shows the inflamed bursa as hypodense with an enhancing wall. However, some knee pain syndromes that have been commonly labelled bursitis are actually unrelated to bursae. The mri machine uses a large magnet and a computer to take pictures of the inside of your body. Mri best illustrates the bursa and related pathology. Infrapatellar bursitis in children with juvenile idiopathic. Redness and swelling of left infrapatellar bursa picture on right. Superficial bursitis, as well as prepatellar, infrapatellar, medial collateral ligament, anserine, iliotibial tract, lateral collateral ligamentbiceps femoris bursitis, often occurs as a result of overuse and may be caused by occupational or everyday activities. If one becomes inflamed due to injury, this is known as infrapatellar bursitis. On mr imaging, a normal infrapatellar plica is best appreciated on sagittal images as a thin, lowsignal, curvilinear structure coursing between the intercondylar notch and the inferior pole of the patella or. Normally, the prepatellar bursa does not communicate with the joint space and contains a minimal amount of fluid. Bursitis should be differentiated from subcutaneous edema on imaging.