Suprapatellar Bursitis & Joint Effusion – Causes, Symptoms and Treatments

Suprapatellar Bursitis, also known as suprapatellar synovitis, popliteal cyst suprapatellar recess, or suprapatellar pouch, is a painful condition that occurs when the fluid within the joint becomes infected.

This article will explore how to treat a patient with this type of effusion after dissecting the anatomy and reviewing images. Then, we’ll check how you can detect suprapatellar joint effusions on a physical exam.

Definition

The term “suprapatellar” refers to the area of the knee located above (supra) and in front of (patella) the patella. Suprapatellar Bursitis can be caused by trauma, overuse from strenuous exercise, infection due to bacteria entering through an open wound in this region of your body, or even obesity.

Anatomy

The suprapatellar pouch can be found under the kneecap and is also known as the popliteal space. It is located in humans, monkeys, and other primates. It can also be found in some quadrupeds, such as dogs and horses. The suprapatellar pouch is a potential space and not a cavity. It can communicate with the underlying synovial joint capsule or synovial membrane.

Symptoms

Symptoms include pain around your kneecap and swelling near your kneecap during activity. You may also experience discomfort while sitting with a straight leg for prolonged periods and difficulty bending your leg.

Diagnoses

Suprapatellar Bursitis is diagnosed through physical examination and diagnostic imaging such as X-rays or MRI to rule out other orthopedic conditions like arthritis. Your physician may order an aspiration for fluid from the knee joint to diagnose a bacterial infection known as septic arthritis.

If your physician diagnoses you with Suprapatellar Bursitis, they may prescribe pain medications to reduce the discomfort and help prevent bone loss from immobility. Treatment options can include an oral antibiotic or a course of intravenous antibiotics if it’s determined that bacteria are causing this condition. Your doctor might also recommend surgery to remove the Bursitis.

Suprapatellar Pouch

The suprapatellar pouch is a fluid-filled cavity beneath the patella that may become blocked with synovium. To treat this type of blockage, it’s recommended to remove the obstruction to restore normal function so that it can be adequately treated down the line if necessary.

Suprapatellar Joint Effusion

The suprapatellar joint is the knee’s most distal synovial articulation. It is located beneath the patella or kneecap.

The suprapatellar joint houses a fluid-filled cavity, which may become blocked with synovium, or fluid. To treat this type of blockage, It’s recommended to remove the obstruction to restore normal function so that it can be appropriately treated down the line if necessary.

Suprapatellar Fat Pad

The suprapatellar fat pad is a small, triangular-shaped cushion of adipose tissue and fibrous tissue that sits on the distal end of the femur. It helps to protect the surrounding ligaments from friction during knee flexion.

Treatment & Management

Suprapatellar pouch treatments may include draining the excess fluid, injecting medication into the area, or performing a needle aspiration to remove accumulated fluids.

Draining

An ultrasound-guided drain can be placed through an incision in front of the knee to reach and open up the suprapatellar pouch. A probe is then used on this point until it’s found that there is no more fluid being drained.

Needle aspiration

A needle is inserted into the suprapatellar pouch through an incision behind the knee, and a syringe plunger is used to aspirate any fluids accumulated inside it. The process can be repeated until all synovial fluid has been removed from this location to treat the inflammation.

Injecting

Synovial fluid may be injected into the suprapatellar pouch to reduce swelling and provide pain relief from other symptoms of joint effusion, such as flu-like sensations or shooting pains in the back of the knee cap. This is often done with a needle inserted through an incision behind the knee.

Trigger Point Injection

A trigger point injection can be performed on a muscle called the popliteus. It is often found in people who have synovial fluid build-up in their suprapatellar pouch from kneeling for prolonged periods. This is done to reduce any inflammation and pain located around this area.

Suprapatellar Pain

It’s a pain in the knee associated with pressure and pinching of the patellar tendon below the kneecap.

Symptoms: pain, tenderness over the iliotibial band or at bony prominence on the lateral side of knee joint/patella; a restricted range of motion in knee joint flexion.

Causes: suprapatellar pain can be caused by various factors, including patellofemoral problems. It is also common in patients with iliotibial band syndrome or shin splints and other conditions that cause inflammation of the bone or cartilage under the kneecap.

Treatment: initially rest from aggravating activities; ice to reduce swelling, then heat for chronic pain relief; strapping over the affected area for support during training; stretching exercises for muscles on the lateral side of lower leg/knee joint (including quadriceps muscle) to relieve tensing around knee joint capsule. If symptoms persist despite conservative treatment, recommend referral to a specialist such as an orthopedist or physiotherapist.

Suprapatellar Fat Pad Impingement

Suprapatellar fat pad impingement is when the fatty tissue around the knee area, called suprapatellar fat pad, gets trapped between two contact points at or near this joint. When one of these surfaces moves vertically (up and down) concerning the other surface, it irritates the fat tissue.

Symptoms: Painful patella tendonitis; swelling over the front side of the kneecap.

Treatment: Reduce weight if overweight or obese; Wear shoes with a low-rise heel for flat feet; Lose excess weight by dieting and exercising more – including walking on an incline treadmill machine; by running shoe inserts, etc.; Apply ice pack after exercise/activity that may have irritated the suprapatellar fat pad.

Since this condition is caused by excessive weight, one way to manage it is by reducing weight if overweight or obese. The other treatment option is wearing shoes with a low-rise heel for flat feet and losing excess weight through dieting and exercising more – including walking on an incline treadmill machine.

One can also buy running shoe inserts that help alleviate symptoms such as pain in patella tendonitis or swelling over the front side of the kneecap. Applying ice packs after activities may have irritated the suprapatellar fat pad helps reduce inflammation.

The good news about this condition is that it does not require surgery; however, underweight people face a higher risk of developing it. To prevent this condition, people should aim to maintain a healthy weight by following their doctor’s advice or an eating plan that suits them best for the long term.

Suprapatellar Reflex

The suprapatellar reflex is palpable at the front of the knee when a sharp tap on the patella tendon causes an involuntary contraction and flexion of this muscle. Neurological testing can also test spinal cord pathology in isolation from other nerve roots (i.e., if there’s no response below L-L). A bilateral loss combined with absent or reduced right lower extremity sensation suggests compression of that particular lateral spinous process by herniated disc material trapped between vertebrae; however, caution should be taken when interpreting these results because symptoms may vary depending upon positioning relative to gravity.

This type of abnormal reflex could indicate An injury where damage has occurred to the femoral nerve or an injury to the tibial and common peroneal nerves with subsequent damage to adjacent muscles of the leg.

Suprapatellar Pouch Calcification

An example of calcification may be found in the suprapatellar pouch. This small area can become inflamed and painful when fluid or other substances build-up, then harden as calcium deposits.

The pain often arises from an allergic reaction to proteins released by cells during necrosis (death) and cell lysis. It usually responds well to treatment with anti-inflammatory medications like ibuprofen. Still, if not adequately treated, it can lead to chronic inflammation of the synovial membrane surrounding the knee joint, leading to osteoarthritis.

Supracondylar Suprapatellar Suspension

Supracondylar suprapatellar suspension is an approach to treating patella instability. The surgeon suspends the knee by attaching an implant on both sides of the knee joint (one side attached outside and below and one inside).

This procedure helps stabilize your kneecap and keeps it from slipping out from under your thigh bone.

The best candidates for Supracondylar suprapatellar suspension are people with severe instability cases. They cannot bear weight or walk comfortably without their symptoms worsening after kneeling or going upstairs.

Typical recovery time could be between three months to six months depending on how soon you start physical therapy afterward and other factors such as age, activity level before injury, etc.

Suprapatellar Tibial Nailing Technique

A suprapatellar tibial nail is a type of orthopedic implant that can be used to stabilize fractures in the knee. These implants are often inserted during surgery to align and repair broken bones near the kneecap or patella. The nails work using a screw-like structure to hold metal plates over the fracture site, with screws holding these plates together against each other.

The most common complication associated with this procedure may include infection at surgical sites (which occurs in sporadic cases), nerve injury (less than one percent of the time), failure of fixation devices, and complications from anesthesia such as allergic reactions or cardiac arrest. Occasionally, postoperative bleeding will require additional blood transfusion for treatment.

The screws must be removed later, and the implant is then replaced with an external fixator. The patient should also avoid contact sports two to four months after surgery due to potential risks of re-fracturing or implants loosening. Once healing has progressed sufficiently, the bone can begin rehabilitation exercises and eventually return to high-impact activities such as running or jumping.

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