Infrapatellar bursitis: a practical overview

Pressure from kneeling or repeated friction can irritate the bursa, while a wound or infection can produce more urgent symptoms. Diagnosis depends on the location, appearance and behaviour of the swelling rather than the name alone.

The bursa acts as a low-friction layer where tissues move over the front of the knee. Inflammation can cause a discrete swelling below the patella, pain with pressure and sometimes warmth. The pattern differs from pain in the patellar tendon or fluid inside the knee joint, so an examination is useful. If the swelling is hot, red, rapidly progressive or associated with fever, a clinician may need to test bursal fluid and treat infection.

Initial care commonly involves removing the provoking pressure, protecting the area with padding and maintaining comfortable knee movement. Medication for inflammation may be suitable for some people but can be unsafe with certain conditions or other medicines, so obtain individual advice. Persistent cases may be considered for aspiration or a carefully selected injection after infection has been excluded. Recurring symptoms also call for review of kneeling technique, equipment and workload.

Arrange an appointment for ongoing or recurrent swelling, unexplained pain or reduced function. Seek urgent care if the skin becomes increasingly red or hot, fluid leaks from the area, fever develops, pain becomes severe or you cannot put weight through the leg. Do not attempt needle drainage at home because it can introduce infection and may miss a deeper problem.

Ask whether the bursa, tendon or joint is involved; whether fluid should be tested; which activities can continue with protection; and what follow-up is needed if the swelling returns after treatment.