What is the role of lab tests in the workup of prepatellar bursitis (housemaid's knee)?

Characteristic	Septic bursitis (SB)	Nonseptic bursitis (NSB)
Appearance	Purulent	Serosanguineous, straw colored, or bloody
White blood cell count per µL	1500-300,000; mean 75,000	50-10,000; usually < 3000
Differential count	Polymorphonuclear (PMN) cells	Predominantly mononuclear cells
Bursal fluid–to–serum glucose ratio	< 50%	>50%
Gram stain	Positive in 70%	Negative
Culture	Positive	Negative

Aguiar RO, Viegas FC, Fernandez RY, Trudell D, Haghighi P, Resnick D. The prepatellar bursa: cadaveric investigation of regional anatomy with MRI after sonographically guided bursography. AJR Am J Roentgenol. 2007 Apr. 188 (4):W355-8. [Medline].
Truong J, Ashurst JV. Septic Bursitis. StatPearls. 2020 Jan. [Medline]. [Full Text].
Rishor-Olney CR, Pozun A. Prepatellar Bursitis. StatPearls. 2020 Jan. [Medline]. [Full Text].
SHARRARD WJ. Haemobursa in kneeling miners. Proc R Soc Med. 1961 Dec. 54:1103-4. [Medline].
Myllymaki T, Tikkakoski T, Typpo T, Kivimaki J, Suramo I. Carpet-layer's knee. An ultrasonographic study. Acta Radiol. 1993 Sep. 34 (5):496-9. [Medline].
Richard W Martyn. Treatment of "Housemaid's Knee". Br Med J. 1861 Nov 23. 2:565.
Ciaschini M, Sundaram M. Radiologic case study. Prepatellar Morel-Lavallée lesion. Orthopedics. 2008 Jul. 31(7):626, 719-721. [Medline].
Borrero CG, Maxwell N, Kavanagh E. MRI findings of prepatellar Morel-Lavallée effusions. Skeletal Radiol. 2008 May. 37(5):451-5. [Medline].
Wilson-MacDonald J. Management and outcome of infective prepatellar bursitis. Postgrad Med J. 1987 Oct. 63 (744):851-3. [Medline].
Gendernalik JD, Sechriest VF 2nd. Prepatellar septic bursitis: a case report of skin necrosis associated with open bursectomy. Mil Med. 2009 Jun. 174(6):666-9. [Medline].
Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011 Mar. 35(3):355-8. [Medline]. [Full Text].
Gendernalik JD, Sechriest VF 2nd. Prepatellar septic bursitis: a case report of skin necrosis associated with open bursectomy. Mil Med. 2009 Jun. 174(6):666-9. [Medline].
Diering N, Klinger HM, Schon MP, Mossner R. Calcific prepatellar bursitis in a patient with limited cutaneous systemic sclerosis. J Dtsch Dermatol Ges. 2017 Dec. 15 (12):1248-50. [Medline].
Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017 Feb 15. 95 (4):224-31. [Medline]. [Full Text].
Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 Jun. 19 (6):359-67. [Medline].
Cariello PF, Wickes BL, Sutton DA, Castlebury LA, Levitz SM, Finberg RW, et al. Phomopsis bougainvilleicola prepatellar bursitis in a renal transplant recipient. J Clin Microbiol. 2013 Feb. 51 (2):692-5. [Medline].
Almajid FM. A Rare Form of Brucella Bursitis with Negative Serology: A Case Report and Literature Review. Case Rep Infect Dis. 2017. 2017:9802532. [Medline].
Wallach JC, Delpino MV, Scian R, Deodato B, Fossati CA, Baldi PC. Prepatellar bursitis due to Brucella abortus: case report and analysis of the local immune response. J Med Microbiol. 2010 Dec. 59 (Pt 12):1514-8. [Medline].
Traboulsi R, Uthman I, Kanj SS. Prepatellar Brucella melitensis bursitis: case report and literature review. Clin Rheumatol. 2007 Nov. 26 (11):1941-2. [Medline].
MacLean S, Kulkarni S. Tuberculosis of the patella masquerading as prepatellar bursitis. Ann R Coll Surg Engl. 2013 Jan. 95 (1):e17-9. [Medline].
Wood LR, Peat G, Thomas E, et al. The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults. Osteoarthritis Cartilage. 2008 Jun. 16(6):647-53. [Medline].
Tuff T, Chrobak K. Septic olecranon and prepatellar bursitis in hockey players: a report of three cases. J Can Chiropr Assoc. 2016 Dec. 60 (4):305-10. [Medline]. [Full Text].
Katwilat P, Chongtrakool P, Muangsomboon S, Jitmuang A. Prototheca wickerhamii prepatellar bursitis in an immunocompetent woman: A case report. J Mycol Med. 2019 Dec. 29 (4):361-4. [Medline].
Krishna R, Rathod A, Preetham. Massive pre-patellar bursitis – a case report. Indian J Orthop Surg. 2015 Apr-Jun. 2(2):124-6. [Full Text].
Northam MC, Gaskin CM. Presumed prepatellar fibrosis in collegiate wrestlers: imaging findings and clinical correlation. Skeletal Radiol. 2015 Feb. 44 (2):271-7. [Medline].
Baumbach SF, Lobo CM, Badyine I, et al. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014 Mar. 134(3):359-70. [Medline].
von Dach E, Uckay I, Agostinho A, et al. One- versus two-stage bursectomy for septic olecranon and pre-patellar bursitis: a prospective randomized study. American Society for Microbiology. Available at https://www.asm.org/index.php/asm-newsroom/journal-tip-sheets/371-news-room/icaac-releases/93720-one-versus-two-stage-bursectomy-for-septic-olecranon-and-pre-patellar-bursitis-a-prospective-randomized-study. Sep 18, 2015; Accessed: Oct 20, 2015.
Uckay I, von Dach E, Perez C, et al. One- vs 2-Stage Bursectomy for Septic Olecranon and Prepatellar Bursitis: A Prospective Randomized Trial. Mayo Clin Proc. 2017 Jul. 92 (7):1061-9. [Medline].
Meade TC, Briones MS, Fosnaugh AW, Daily JM. Surgical Outcomes in Endoscopic Versus Open Bursectomy of the Septic Prepatellar or Olecranon Bursa. Orthopedics. 2019 Jul 1. 42 (4):e381-4. [Medline].
[Guideline] Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1. 52 (3):e18-55. [Medline]. [Full Text].
Martinez-Taboada VM, Cabeza R, Cacho PM, et al. Cloxacillin-based therapy in severe septic bursitis: retrospective study of 82 cases. Joint Bone Spine. 2009 Jul 1. [Medline].

Characteristic	Septic bursitis (SB)	Nonseptic bursitis (NSB)
Appearance	Purulent	Serosanguineous, straw colored, or bloody
White blood cell count per µL	1500-300,000; mean 75,000	50-10,000; usually < 3000
Differential count	Polymorphonuclear (PMN) cells	Predominantly mononuclear cells
Bursal fluid–to–serum glucose ratio	< 50%	>50%
Gram stain	Positive in 70%	Negative
Culture	Positive	Negative

Author

Divakara Kedlaya, MBBS Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief Medical Officer, William Beaumont Army Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, American Association for Physician Leadership, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Kelly L Allen, MD † Medical Director, Medevals

Disclosure: Nothing to disclose.

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Guy W Fried, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University; Chief Medical Officer, Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital

Guy W Fried, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

What is the role of lab tests in the workup of prepatellar bursitis (housemaid's knee)?

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