* Prepatellar bursitis occurs when the bursa at the front of the knee becomes inflamed and fills with excess fluid.
*When inflamed, a bursa’s normally thin lining thickens and produces excess fluid. The excess fluid collects in the bursa sac, causing it to swell.
Causes
Frequent kneeling:
* Most cases of prepatellar bursitis are caused by pressure and irritation from frequent kneeling.
A direct hit to the knee:
*Trauma to your knee from falling or getting hit with something can cause prepatellar bursitis.
* Bursa is a thin, slippery, fluid-filled sac that serves as both a cushion and a lubricant between kneecap and skin.
* When inflamed, a bursa’s normally thin lining thickens and produces excess fluid. The excess fluid collects in the bursa sac, causing it to swell.
*When the prepatellar bursa is inflamed, it fills with fluid, causing the front of the knee to look swollen.
* There are many reasons a prepatellar bursa may become inflamed, such as repeated irritation, an injury, or an underlying inflammatory condition.
*Repeated irritation from kneeling is the most common reason.
Symptoms
Swelling at the front of your knee: Nearly all cases of prepatellar bursitis involve swelling at the front of your 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. If your prepatellar bursitis isn’t treated, the swelling can increase.
Range of motion limits in your knee:
* Mild and moderate cases of prepatellar bursitis usually don’t limit your ability to bend and stretch your knee.
* If you have a severe case of prepatellar bursitis, you may not be able to move your knee like you usually do.
Pain: Some people don’t experience pain with prepatellar bursitis. Others may feel achiness or tenderness in their affected knee even while resting.
* Sometimes, people with prepatellar bursitis experience no pain while resting but feel pain or tenderness in their affected knee when they kneel or bend it.
* Having reddish or pinkish skin where your knee is swollen.
* Having warmer skin where your knee is swollen.
* Having a fever.
* Experiencing achiness and chills.
Diagnosis of knee bursitis
Bursitis of the knee is diagnosed based on the typical location
of a bursa displaying signs of inflammation including
* knee pain,
* tenderness,
* stiffness, and
sometimes redness and warmth.
Typically, there is point tenderness at the site of the inflamed bursa.
Physiotherapy management
1.Ultrasonic therapy :
* Ultrasound therapy helpful in treating knee bursitis.when the fluid-filled sacs in the joints become inflamed.
* This therapy is a noninvasive treatment in which sound waves are used to penetrate soft tissues, increasing blood flow. This can help relieve pain, improve circulation, and promote tissue healing.
2.Dry Needling :
*Dry needling is applied to an affected muscle or trigger point, it can decrease muscle tightness, increase blood flow and reduce pain.
* Patients often report immediate relief after treatment. The needles remain in your muscle for a short period of time — between 10 seconds and 20 minutes — during treatment. This depends on the treatment location,
number of needles used and treatment goals.
* Dry needling usually is paired with exercise and other physical therapy techniques to prevent trigger points from reoccurring.
3.Manual therapy:
* Manual therapy is the manual pressure to the skin, muscles and tendons, ligaments and fascia.
*Myofascial Release address the restrictions in the fascia. Fascia is a web of connective tissue covering and connecting the muscles, joints and organs within the whole body.
*Trigger points release. Myofascial trigger points (MTPs) are focal areas of tenderness within a muscle belly which usually respond to a referred pain at the distance of the point.
Exercises for Knee bursitis
1.Heel slide
*Lie on your back with your affected leg straight. Bend your other leg.
* Slowly bend your affected leg by raising your knee up while sliding your foot toward you.
* Bend your knee as much as you can.
* Hold for about 6 seconds. Then slowly slide your foot away, lowering your leg back down.
* Repeat 8 to 12 times.
* repeat these steps with your other leg.
2.Quad set
* Sit or lie down on a firm surface or the floor with your affected leg straight.
* Place a small, rolled-up towel under your knee.
* Tighten the thigh muscles of your straight leg by pressing the back of your knee down into the towel.
* Hold for about 6 seconds, then rest.
3.Hip flexion (lying down, leg straight)
* Lie on your back with your affected leg straight.
*You can bend your other leg, if that feels more comfortable.
* Tighten the thigh muscles in your affected leg by pressing the back of your knee down.
*Hold your knee straight.
*Keeping the thigh muscles tight and your leg straight, lift your affected leg up so that your heel is about 12 inches off the floor.
*Hold for about 6 seconds, then lower slowly.
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