Deep Infrapatellar Bursitis

THE CLINICAL SYNDROME

The deep infrapatellar bursa is vulnerable to injury form both acute trauma and repeated microtrauma. The superficial infrapatellar bursa lies between the subcutaneous tissues and the upper part of the ligamentum patellae. The deep infrapatellar bursa lies between the ligamentum patellae and the tibia. These bursae may exist as single bursa sacs or, in some patients, as a multisegmented series of sacs that may be located in nature. Acute injuries frequently take the form of direct trauma to the bursa via falls directly onto the knee or from patellar fractures, as well as from overuse injuries, including running on soft or uneven surfaces. Deep infrapatellar bursitis may also result from jobs requiring crawling and kneeling on the knees, such as carpet laying or scrubbing floors. If the inflammation of the superficial infrapatellar bursa becomes chronic, calcification of the bursa may occur.

Deep infrapatellar bursitis commonly presents as inferior knee pain accompanied by a catching sensation, especially on rising from a sitting position.

SIGNS AND SYMPTOMS

The patient suffering from deep infrapatellar bursitis will frequently complain of pain and swelling in the anterior knee below the patella that can radiate inferiorly into the area surrounding he knee. Often, the patient will be unable to kneel or to walk down stairs. The patient may also complain of a sharp, catching sensation with range of motion of the knee, especially on first arising. Infrapatellar bursitis often coexists with arthritis and tendinitis of the knee joint, and these other pathological processes may confuse the clinical picture.

Physical examination may reveal point tenderness in the anterior knee just below the patella. Swelling and fluid accumulation surrounding the lower patella are often present. Passive flexion as well as active resisted extension of the knee will reproduce the pain. Sudden release of resistance during this maneuver will markedly increase the pain. The deep infrapatellar bursa is not as susceptible to infection as the superficial infrapatellar bursa.

TREATMENT

A short course of conservative therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2 inhibitors and a knee brace to prevent further trauma is a reasonable first step in the treatment of patients suffering from deep infrapatellar bursitis. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step. To inject the deep infrapatellar bursa, the patient is placed in the supine position with a rolled blanket underneath the knee to gently flex the joint. Coexistent bursitis, tendinitis, arthritis, and internal derangement of the knee may also contribute to the patient’s pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The described injection technique is extremely effective in the treatment of pain secondary to deep infrapatellar bursitis. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for infrapatellar bursitis pain. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.