EDP column by Professor Ketan Dhatariya

“My GP tells me I have ‘Housemaids Knee’ – what is this?”

Joints are very complex. To help them to bend, and to allow the structure in the joints to smoothly slide over each other, they need lubrication.  This lubricant is found in small bags of fluid in different areas around the joints. A bag of fluid is called a bursa. When the bursa is damaged – either by sudden trauma or infection, or by long term pressure, the bursa may become inflamed, and so you would get ‘bursitis’. Each knee has fifteen of these bursae, but the one that becomes most frequently inflamed is the one that lies just in front of the knee cap – the ‘pre-patellar’ bursa. Housemaids knee is where this bursa becomes inflamed over a long period of time and is thus known as ‘pre-patellar bursitis’. The condition was named because of the nature of the work that housemaids did. They spent long periods of time on their knees cleaning. These days it is professions such as carpet fitters or gardeners who are more prone to this condition.

Kneeling for long periods of time caused long term damage and inflammation to the bursa. The symptoms include pain and tenderness on the kneecap and just below it. The knee cap may be swollen making kneeling difficult, and when the condition goes on for a long time, there may be a tender lump floating underneath the skin on the kneecap.

It is important to avoid aggravating the knee, and so to avoid kneeling or repeated trauma – or, if that cannot be avoided, to use good quality knee pads. Ice packs or heat treatment, and painkillers such as anti-inflammatory drugs are useful. In some cases, if the swelling gets too big, your GP may either inject some steroid into the joint, or may suck out some of the fluid using a needle and syringe. Very rarely, surgery is needed.