Diagnosis Explanation:

Prepatellar bursitis is inflammation of the prepatellar bursa, a fluid-filled sac in front of the kneecap (patella) that cushions and reduces friction. It is often caused by repetitive kneeling, direct trauma, infection, or overuse. Symptoms include swelling in front of the kneecap, tenderness, warmth, and pain when bending the knee or applying pressure. In severe cases, the bursa may become infected (septic bursitis), requiring antibiotics.

Specific Work Modifications:

• If your job requires standing or walking: Wear shock-absorbing footwear and avoid prolonged standing without breaks.
• If your job involves kneeling: Use knee pads or a cushioned surface to reduce pressure.
• If your job is desk-based: Keep the knee elevated when sitting and avoid prolonged knee flexion.
• Avoid: Direct pressure on the kneecap, excessive bending, deep squats, and prolonged standing without breaks.

Specific Activity Modifications:

• If you run or play sports: Avoid high-impact activities until swelling subsides; switch to swimming or cycling for low-impact movement.
• If you hike: Use trekking poles and avoid kneeling or excessive knee flexion on rough terrain.
• If you do weightlifting: Avoid deep squats, lunges, and kneeling exercises; focus on controlled leg exercises without knee pressure.
• Avoid: Kneeling, high-impact jumping, deep squats, and activities that worsen knee swelling.

Recommended Supplements:

• Collagen Peptides – 10g daily for soft tissue repair.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Vitamin C – 500mg daily to promote collagen synthesis.
• Turmeric (Curcumin) – 500-1000mg daily for natural pain relief.
• Magnesium – 300-400mg daily to aid muscle relaxation.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, tofu, eggs) to support tissue healing.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain joint lubrication.
• Limit Processed Foods & Sugars to minimize inflammation.
• Hydration: Drink 8-10 cups of water daily to support joint health and healing.

Home Exercise Prescription (Rehabilitation for Prepatellar Bursitis)

Early Phase (0-2 Weeks, Reducing Pain & Swelling):

• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression (knee sleeve), Elevation.
• Quadriceps Sets – Tighten thigh muscle, hold for 5 seconds, repeat 10 reps, 3x/day.
• Seated Knee Extensions – Slowly extend knee, hold for 5 seconds, repeat 10 reps, 2x/day.
• Ankle Pumps – Move ankle up and down to improve circulation, 10 reps, 3x/day.

Strengthening Phase (2-6 Weeks, Improving Stability & Mobility):

• Straight Leg Raises – Keep knee straight, lift leg, hold 5 seconds, repeat 10 reps, 2x/day.
• Mini Squats (No Deep Bending) – Slight knee bends while keeping weight on heels, 10 reps, 2x/day.
• Glute Bridges – Lie on back, lift hips while keeping knees bent, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Strengthening & Preventing Recurrence):

• Step-Ups – Step onto a low platform, push through the heel, repeat 10 reps, 2x/day.
• Stationary Cycling – Low resistance for 10-15 minutes/day to improve knee mobility.
• Balance Exercises – Stand on injured leg for 10-20 seconds, increase as tolerated.

Helpful Books:

1. The Knee Injury Bible: Everything You Need to Know About Knee Pain, Prevention, and Treatment – Kevin R. Stone, MD.
2. Heal Your Knees: How to Prevent Knee Surgery and What to Do If You Need It – Robert Klapper, MD, and Lynda Huey.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.