Patellar Bursitis: Symptoms, Relief, and UK Online Doctor Guidance

Patellar bursitis, also known as prepatellar bursitis or colloquially as 'housemaid's knee', is a condition characterised by inflammation of the prepatellar bursa. The bursa is a small, fluid-filled sac located just in front of the kneecap (patella). Its primary role is to reduce friction between the skin and the bone as you move your knee.

When this sac becomes irritated or inflamed, it produces excess fluid, causing the front of the knee to swell. In the UK, this condition is frequently seen in tradespeople, gardeners, and athletes who spend significant time kneeling or are subject to repetitive knee trauma. While uncomfortable, most cases of patellar bursitis are non-infectious and respond well to rest and self-care measures aligned with NHS guidance.

Recognising the Symptoms

The most obvious sign of patellar bursitis is swelling over the front of the kneecap. Unlike arthritis, which affects the joint itself, the swelling in bursitis is superficial. You may notice:

• A visible lump or soft swelling at the front of the knee.
• Pain or tenderness when pressure is applied (especially when kneeling).
• Restricted movement if the swelling is significant.
• Redness or warmth in the area (which may indicate infection).

Primary Causes

The condition is typically caused by one of three factors:

• Repetitive Pressure: Prolonged kneeling on hard surfaces is the most common cause, leading to the name 'housemaid’s knee'.
• Acute Trauma: A direct blow to the front of the knee, such as a fall or a sporting injury, can trigger inflammation.
• Infection (Septic Bursitis): A cut or graze near the knee can allow bacteria to enter the bursa. This is a more serious form that requires prompt medical attention.

For non-infectious patellar bursitis, the first line of treatment involves conservative management. Following the NICE (National Institute for Health and Care Excellence) recommendations for musculoskeletal pain, patients should implement the RICE protocol:

• Rest: Avoid activities that aggravate the knee, particularly kneeling.
• Ice: Apply an ice pack wrapped in a towel for 15-20 minutes every few hours to reduce swelling.
• Compression: A light elastic bandage can help manage the fluid buildup.
• Elevation: Keeping the leg raised above the level of the heart can encourage drainage.

Over-the-counter medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be effective for managing pain and reducing inflammation. Always consult a pharmacist or doctor before starting new medication to ensure it is suitable for you.

If your knee swelling does not improve after 48 to 72 hours of self-care, or if the pain is interfering with your daily life, it is advisable to seek medical advice. You can speak to a GP online to discuss your symptoms and receive a professional assessment without leaving your home.

An online doctor can help by:

• Reviewing your medical history and the mechanism of injury to confirm a likely diagnosis.
• Providing advice on the appropriate use of anti-inflammatories.
• Issuing a private prescription if stronger medication is required.
• Discussing whether you need a referral for physical therapy or an in-person clinical examination.
• Providing a sick note if your occupation involves heavy kneeling and you require time off to recover.

Online consultations are particularly useful for follow-up care and for those who need guidance on how to prevent the condition from recurring through ergonomic changes or the use of knee pads.

Preventing the recurrence of patellar bursitis is crucial, especially if your job or hobbies put you at risk. British health professionals often recommend the following preventative measures:

• Use Knee Pads: If you must kneel, always use high-quality, cushioned knee pads or a kneeling mat.
• Take Regular Breaks: Shift your position frequently and stand up to stretch to relieve constant pressure on the bursa.
• Strengthening Exercises: Building strength in the quadriceps and hamstrings can help support the knee joint, though these should only be started once the acute inflammation has subsided.
• Weight Management: Reducing excess body weight can lower the overall pressure exerted on the knee joints during daily activities.

If the bursa remains persistently swollen (chronic bursitis), a GP may recommend an in-person visit for aspiration, where the excess fluid is drained using a needle, or in rare cases, a corticosteroid injection.