Ultrasound-Guided Cortisone for Prepatellar Bursitis

Introduction

Prepatellar bursitis is a condition that affects the front of the knee, causing swelling, tenderness, and functional discomfort. It arises when the prepatellar bursa, a small fluid-filled sac located in front of the kneecap (patella), becomes irritated or inflamed.

At Joint Injections, we understand how limiting knee pain can be, especially when linked to bursitis. Our clinicians use advanced diagnostic imaging and targeted treatment strategies, including ultrasound-guided cortisone injections, to address the affected area with precision. This blog provides an in-depth overview of prepatellar bursitis, covering its anatomy, pathology, symptoms, diagnosis, and management, while explaining the role and mechanism of cortisone in treatment.

Anatomy of the Prepatellar Bursa

The knee joint contains several bursae — fluid-filled sacs that act as cushions to reduce friction between soft tissues and bone.

  • Prepatellar Bursa: Located directly in front of the patella, between the skin and the kneecap.
  • Its role is to facilitate smooth movement of the skin over the knee during bending, kneeling, and other activities.

Due to its superficial position, the prepatellar bursa is highly vulnerable to repeated friction and direct trauma.

Pathology of Prepatellar Bursitis

Prepatellar bursitis develops when the bursa becomes irritated or inflamed.

Common causes include:

  • Repetitive kneeling (often seen in trades such as carpet fitting, plumbing, or gardening — hence the name “housemaid’s knee”).
  • Direct trauma to the kneecap.
  • Infections that can spread to the bursa.
  • Underlying conditions such as gout or rheumatoid arthritis.

The inflammation leads to excess fluid accumulation, resulting in swelling and discomfort at the front of the knee.

Risk Factors

Factors that increase the likelihood of developing prepatellar bursitis include:

  • Occupations requiring frequent kneeling.
  • Repetitive sports activities involving knee impact.
  • Previous injuries to the knee.
  • Presence of systemic conditions like gout or arthritis.

Symptoms and Clinical Features

The typical signs of prepatellar bursitis are:

  • Noticeable swelling at the front of the knee.
  • Pain and tenderness over the kneecap.
  • Redness and warmth if infection is present.
  • Difficulty kneeling, squatting, or climbing stairs.
  • Restriction in mobility due to swelling.

Diagnosis

A diagnosis is established through clinical examination and imaging where required.

  • Clinical Examination: The swollen bursa can often be detected by sight and touch.
  • Ultrasound: Provides real-time imaging to confirm bursal fluid accumulation and differentiate from other knee pathologies.
  • Aspiration: Fluid may be aspirated in suspected cases of infection to guide further management.

Management of Prepatellar Bursitis

Treatment varies depending on the underlying cause and severity.

Conservative Measures

  • Rest and avoidance of prolonged kneeling.
  • Application of ice and compression to reduce swelling.

Interventional Measures

When conservative management is insufficient, ultrasound-guided cortisone injections may be considered.

Role of Ultrasound Guidance

Ultrasound guidance is valuable in prepatellar bursitis treatment because:

  • It provides a clear image of the inflamed bursa.
  • It ensures precise needle placement.
  • It reduces the risk of injury to adjacent structures.
  • It allows clinicians to deliver cortisone directly into the affected bursa.

Cortisone and Its Mechanism of Action

Cortisone is a corticosteroid commonly used in musculoskeletal conditions to address inflammation.

Its mechanism of action includes:

  • Reducing the release of pro-inflammatory chemicals in the bursa.
  • Minimising swelling by decreasing vascular permeability.
  • Modulating the immune response in the inflamed tissue.
  • Decreasing nociceptive signalling, which can reduce the perception of pain.

By targeting the local inflammatory process, cortisone injections may help restore comfort and allow a return to daily activities.

Benefits of Ultrasound-Guided Cortisone Injections

At Joint Injections, cortisone injections for prepatellar bursitis are always performed under ultrasound guidance, offering:

  • Accurate targeting of the inflamed bursa.
  • Increased precision compared to non-guided injections.
  • Real-time monitoring during the procedure.
  • An individualised approach tailored to each patient.

Why Choose Joint Injections

Choosing Joint Injections for your care offers several advantages:

  • Experienced Clinicians: Injections are performed by clinicians with expertise in musculoskeletal medicine.
  • Precision and Safety: All procedures are ultrasound-guided for accuracy.
  • Personalised Care: Treatment plans are developed to address individual needs.
  • Comprehensive Support: We integrate interventional options with wider rehabilitation and management strategies.

Conclusion

Prepatellar bursitis is a common cause of swelling and discomfort at the front of the knee, often related to repetitive kneeling, trauma, or systemic conditions. Accurate diagnosis and management are important for restoring knee comfort and function.

At Joint Injections, our clinicians use ultrasound-guided cortisone injections as one of the available options in a carefully tailored approach to managing prepatellar bursitis. With precision, expertise, and personalised care, our aim is to support each individual on their journey to improved knee health.


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