Infrapatellar bursitis because of prolonged kneeling
Infrapatellar bursitis is an inflammation of the superficial or deep ifrapatellar bursa and can be a source of anterior knee pain. The cause of bursitis is often repetitive trauma or overuse because of prolonged kneeling as a clergyman or cleaner. In a similar case, a 58-year-old suffered from infrapatellar bursitis as a result of trauma. Most cases are painless, however, in case of extreme movements such as squatting may lead to pain as reported by the patient. In this case, the patient belonged to rural India, therefore, it was a standard practice for him to squat.
A 58-year-old male clerk presented to the outpatient department with a 1-year history of painful swelling of the right knee. He had a history of trauma in his knee. Examination was significant for a solitary lump with slight discolouration of the skin. The lump was slightly tender on palpation, measuring 5×5 cm. The pain aggravated on flexion and extension.
Laboratory investigations were within normal limits
Doctors further advised blood investigations, complete blood count and acute phase reactants which were all within normal limit. Other tests including serum uric acid and autoimmune markers also showed normal results. An X-ray of the knee showed soft tissue swelling without the presence of calcification or ossification. As stated in the study, the MRI showed a “well-defined, subcutaneous, elliptical mass in the midline, which was superficial to the tibial tuberosity”. The imaging showed a hypointense mass on T1 and a hyperintense mass on T2, associated with surrounding subcutaneous oedema. Doctors counselled him for an excisional biopsy, removed the mass and sent it for histopathological analysis.
Histopathology showed a soft to firm yellowish mass with no signs of haemorrhage, gritty sensation on cutting or necrosis. Whereas microscopic examination was consistent with chronic inflammation covered with fibrinous debris. The patient was diagnosed with an infrapatellar bursitis. The study further states that an ultrasound is not sufficient for detecting soft-tissue changes and bursitis in the carpet layer.
References
Infrapatellar bursitis presenting as a lump https://casereports.bmj.com/content/14/5/e243581