Dear Ask The Doctor: My friend who is a 38 year old woman had pain in her knee behind the knee cap when kneeling and slight swelling that would respond to ice, elevation and ibuprofen. While playing with her daughter on her back, her daughter's weight caused her knee to bend and before she could respond due to the pain, the knee popped and caused level 10 pain. The next morning the pain was lower than before and now kneeling and full range movement has returned. Has she popped a swollen bursa? Is it panic time? Because I can't get her to go see a doctor.
Dear Dave: Most likely seems, according to your description, that your friend may have had a prepatellar bursitis, this might have been produced by the previous traumatism. The prepatellar bursa is a superficial bursa with a thin synovial lining located between the skin and the patella. Normally, it does not communicate with the joint space and contains a minimal amount of fluid; however, inflammation of the prepatellar bursa results in marked increase of fluid within its space, like a “golf ball”. It is a possibility that with her daughter’s weight the bursa got flattened. Apparently it looks as an uncomplicated knee injury that with conservative treatment has a great chance to improve, anyways if she notices one or more of the following symptoms: more inflammation, remarkable limitation on flexion-extension movements, locking of the knee, or instability, the next step would be an evaluation by an Orthopedic Surgeon. But if this is not the case, the suggested strategy would be: protection (avoid activities or movements that may produce pain, especially kneeling), local ice packs for periods no more than 15 minutes each time, and after, local hot compresses, you could use anti-inflammatory medication (i.e.: “Aleve”, “Advil”). The healing time is different for each patient but generally there is a progressive improvement during the next 4-6 weeks after the injury.