A 46-year-old gardener comes to the office due to knee pain. It began abruptly 3 days earlier and improved only minimally with acetaminophen. The patient spends hours on his knees several times a week while working. Past medical history is notable for hypertension and seasonal allergies. His current medications include lisinopril, loratadine, and fluticasone nasal spray. Examination of the lower extremity shows no visible erythema or abrasions, but there is sharp, localized pain on palpation. Passive range of motion is normal in all joints, but the patient has severe pain when walking around the room or climbing onto the examination table. Which of the following bursae is most likely affected in this patient?

Question

A 46-year-old gardener comes to the office due to knee pain.  It began abruptly 3 days earlier and improved only minimally with acetaminophen.  The patient spends hours on his knees several times a week while working.  Past medical history is notable for hypertension and seasonal allergies.  His current medications include lisinopril, loratadine, and fluticasone nasal spray.  Examination of the lower extremity shows no visible erythema or abrasions, but there is sharp, localized pain on palpation.  Passive range of motion is normal in all joints, but the patient has severe pain when walking around the room or climbing onto the examination table.  Which of the following bursae is most likely affected in this patient?

Quizplus · Accepted Answer

11ec160b_35e2_30f4_9249_bb4397822e6b_MD0001_00 A bursa is a fluid-filled synovial sac that serves to alleviate pressure and friction at bony prominences and ligamentous attachments throughout the body. Bursae are vulnerable to injury from acute trauma or chronic repetitive pressure and may also become inflamed due to infection (septic bursitis), crystalline arthropathy (eg, gout), or autoimmune conditions (eg, rheumatoid arthritis). Because bursae are located in prominent and exposed positions, the pain of bursitis may be exquisite, and point tenderness is typical. Other features of bursitis may include swelling and erythema, particularly with more superficial bursae. Active range of motion is often decreased or painful, but passive motion is usually normal as it results in less pressure on the inflamed bursa. This patient with acute pain and localized tenderness associated with repetitive anterior knee trauma from kneeling has typical features of prepatellar bursitis, sometimes called "housemaid's knee." The prepatellar bursa is located between the patella and the overlying skin. Other occupations associated with prepatellar and infrapatellar bursitis include carpet layers, mechanics, and plumbers. (Choice A) Anserine bursitis presents with pain along the medial knee and well-defined tenderness approximately 4 cm distal to the anteromedial joint margin of the knee. It frequently results from obesity or overuse in athletes. (Choices B and D) Popliteal (Baker) cysts are caused by swelling of the gastrocnemius or semimembranosus bursa. They often form due to extrusion of synovial fluid from the knee joint into the bursa in patients with osteoarthritis or inflammatory joint disease. (Choice E) The suprapatellar bursa is located anteriorly between the distal femur and quadriceps. Bursitis here is most often caused by a direct blow to the distal thigh or prolonged/repetitive quadriceps activity (eg, running). Educational objective: A bursa is a fluid-filled synovial sac that serves to alleviate pressure from bony prominences and reduce friction between muscles and tendons. Acute trauma or chronic repetitive pressure can cause injury, leading to localized pain and tenderness. Prepatellar bursitis causes anterior knee pain and is usually due to repetitive or prolonged kneeling.

A 46-Year-Old Gardener Comes to the Office Due to Knee