INFRAPATELLAR BURSITIS CASE STUDY

This case study explores an interesting presentation we had through the clinic recently.

How they presented / Mechanism of Injury:

  • Patient present with inflammation below the knee cap.
  • Patient reported day prior to swelling, they increased repetitive lunging and kneeling intermittently for approx. 3hrs. Interestingly patient had no pain.
  • He reported he had noticed the knee swell up over the hours post kneeling/lunging but was not in pain.

Self management between time of injury & presenting:

  • He had iced his knee but the swelling had not gone down.

Assessment:

  • Squat: pain free to 90 degrees
  • Single leg stand: pain free 30sec
  • Single leg Squat: pain free
  • Lunge: NAD
  • Jump x10: NAD
  • Hop x10: NAD
  • Knee Active range of motion: Flexion 95 degrees nil pain but swelling limits AROM. Ext NAD
  • Patella glides stiff but pain free even with compression.
  • Palpation: Nil Tenderness patella tendon or quads tendon.
  • Ligament + meniscus tests: negative

Impression / Diagnosis:

  • Infrapatellar bursitis
  • To confirm the diagnosis, we sent the patient for an ultrasound which he had the following day.

Treatment:

  • Soft tissue massage on quadriceps and hip flexors allowed the patient to regain an additional 10 degrees of knee flexion taking him to 105 degrees.
  • We also released his glutes as he had reduced hip external rotation on his affected side – this allowed him to regain full passive range of motion in his hip
  • Fitted patient with tubigrip (compression sock) to help reduce swelling
  • Education re: benefits of trialling 3-5 days of oral anti-inflammatories to see if swelling subsided.
  • Educated patient on importance of avoiding kneeling, lunging, deep squatting and prolonged sitting in short term until swelling subsided.
  • We then referred patient back to the GP to have the bursa drained two weeks later as the swelling was not reducing with conservative management.Patient had bursa drained and also had a cortisone injection into bursa at the same time.

Home Exercise Programme:

  • Gradual increase in quads strength and Single leg control over approx. 6weeks. Including:
    • Squats
    • Seated knee extension
    • Single Leg balance
    • Side planks
    • Single leg bridges
    • Deadlifts
  • We then progressed to:
    • Bulgarian split squats
    • Arabesques
    • Lunges

Outcome:

Over the following two weeks post injection the bursa slowly reduced in size and the patient regained full range of motion. With gradual re-introduction to exercise, the patient is now back to normal activities with no restrictions.

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