At a Glance - Prepatellar bursa vs Osgood-Schlatter's disease

Dr Jean Watkins discusses the differences between Prepatellar bursa and Osgood-Schlatter's disease

PPB: tender, fluctuant swelling
PPB: tender, fluctuant swelling

Prepatellar bursa (PPB)
Aetiology

  • Bursae are small synovial sacs that often lie over bony prominences, such as the patella.
  • These may increase in size due to inflammation and an increase of fluid following trauma.
  • PPB frequently follows a fall on the knee or repeated pressure (kneeling).
  • Occurs at all ages. Commonly affects carpet layers, plumbers and roofers.

Presentation

  • Pain, swelling and inflammation over the lower pole of the patella.
  • On examination there is tender, fluctuant swelling in this area, and restricted knee flexion.

Management

  • Analgesics, such as NSAIDs.
  • Avoidance of pressure on the knee.
  • Aspiration of the bursa. Send fluid for culture to exclude infection that would require antibiotics.
  • If no infection, corticosteroid injection may be considered.
  • Consider physiotherapy to regain function of quadriceps and hamstrings.
  • X-ray only if suspected fracture.
  • In cases that fail to improve, consider CT or MRI scan.
  • Surgery with bursectomy only for those with chronic and/or recurrent PPB.

Osgood-Schlatter's Disease

Osgood-Schlatter’s: firm mass

Aetiology

  • Traction apophysitis of the tibial tubercle.
  • Common in adolescence, especially in boys. Exacerbated by exercise.
  • Many attribute the problem to recent trauma as the result of repetitive strain.

Presentation

  • Pain and oedema over the tibial tuberosity.
  • Aggravated by kneeling, jumping and walking up and down stairs.
  • One or both knees affected.
  • On examination, tenderness over the tibial tuberosity, which may be inflamed and a firm mass may be felt.
  • Pain aggravated by extension of the knee against resistance.
  • Otherwise normal knee joint.

Management

  • X-ray and other investigations not indicated unless fracture or other condition suspected.
  • Initially may be helped by the frequent application of ice packs and rest.
  • Analgesics, such as NSAIDs.
  • Avoidance of sport.
  • Start quadriceps and hamstring exercises once acute symptoms improve.
  • Self-limiting condition that should resolve spontaneously within a year.
  • Surgery may be considered for those that do not settle.

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