Case Study: Prepatellar Bursitis (Housemaid’s Knee)

Patient Information:

Name: Mrs. Sarah Ali

Age: 45

Gender: Female

Occupation: Housemaid

Socioeconomic Status: Lower middle class

Chief Complaint: Swelling and pain over the front of the knee

Presenting Complaints:

Mrs. Ali presents with complaints of swelling and pain over the front of her right knee. She reports that the symptoms have been gradually worsening over the past few weeks. She finds it difficult to kneel or perform her usual household chores without experiencing discomfort.

History of Presenting Complaints:

The patient reports a history of repetitive kneeling and scrubbing while performing her housemaid duties. She recalls an incident where she bumped her knee against a hard surface, exacerbating the discomfort.

Past Medical and Surgical History:

No significant past medical or surgical history reported.

Family History:

No family history of knee or joint-related conditions reported.

Present and Pre-morbid Functional Status:

Prior to the onset of symptoms, Mrs. Ali was fully functional and able to perform her daily activities without difficulty.

General Health Status:

Overall, the patient is in good general health.

Vitals:

Blood Pressure: 120/80 mmHg

Heart Rate: 76 bpm

Respiratory Rate: 16 breaths/min

Temperature: 98.6°F

Aggravating Factors:

Prolonged kneeling or squatting

Direct pressure on the front of the knee

Easing Factors:

Rest

Elevation of the affected knee

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examination:

Inspection: Swelling and tenderness over the prepatellar region.

Palpation: Warmth, swelling, and tenderness over the prepatellar bursa.

Range of Motion (ROM): Limited flexion due to pain.

Special Tests: Patellar tap test positive, indicating bursal swelling.

Duration of Current Symptoms:

Approximately 4 weeks.

Mechanism of Injury/Current Symptoms:

Repetitive kneeling and a direct impact to the knee exacerbated by occupational activities.

Progression Since the Current Episode:

Symptoms have gradually worsened over the past few weeks.

Significant Prior History:

No significant prior history reported.

Previous Treatment:

Over-the-counter pain relievers (e.g., ibuprofen) for pain management.

Application of ice packs intermittently.

Diagnostic Test/Imaging:

X-ray to rule out any bony abnormalities or fractures.

Differential Diagnosis:

Prepatellar bursitis

Patellofemoral pain syndrome

Osteoarthritis of the knee

Postural Observation:

Antalgic gait observed due to pain in the affected knee.

Precaution and Contraindications:

Avoiding activities that exacerbate knee pain, such as prolonged kneeling or squatting.

Using knee pads or cushioning while performing tasks that involve kneeling.

Functional Movement Analysis (Sign):

Decreased ability to perform activities requiring knee flexion, such as squatting or kneeling.

Quick Screening Tests/Clearing of Additional Joint Structures:

Stability testing of the knee to rule out ligamentous injury.

Range of Motion (ROM):

Limited flexion due to pain.

Special Test:

Patellar tap test positive, indicating bursal swelling.

Assessment:

Prepatellar bursitis secondary to occupational activities.

Problem List/Complaints:

Prepatellar bursitis causing pain and swelling over the front of the knee.

Limited knee flexion due to pain.

Difficulty performing occupational tasks due to knee discomfort.

Treatment:

Activity modification: Avoidance of prolonged kneeling or squatting.

Pain management: NSAIDs for pain relief.

Ice therapy: Application of ice packs to reduce inflammation.

Knee padding: Use of knee pads or cushioning to protect the knee during activities.

Prognosis:

Favorable with appropriate management and activity modification.

Goals:

Reduce pain and inflammation.

Improve knee function and range of motion.

Enable the patient to resume normal activities without discomfort.

Interventions:

Education on proper body mechanics and ergonomic principles to prevent recurrence.

Physical therapy for strengthening and flexibility exercises.

Follow-up appointments for monitoring and reassessment.

Patient Education:

Educate the patient on the importance of activity modification and avoiding exacerbating activities.

Demonstrate proper techniques for knee protection during occupational tasks.

Provide information on medication use and potential side effects.

Patient/Family Education:

Educate family members on ways to support the patient during recovery, such as assisting with household tasks.

Discuss the importance of adherence to treatment and follow-up appointments.

Discharge Plan:

Provide written instructions on home care, including medication management and icing techniques.

Schedule follow-up appointments for reassessment and further management as needed.