· Pharmacological management; The treatment primarily depends on the cause of disease and secondarily on the pathological changes in bursa. The primary goal of treatment is to control the inflammation.
-Conservatively, the R.I.C.E. regimen (rest, ice, compression, elevation) in the first 72 hours after the injury or when the first sign of inflammation appears.
-Medications include non-steroidal anti-inflammatory drugs (NSAIDS), topical medications- sprays, creams, gel and patches can provide pain relief when those are directly applied to the skin over the knee.
-Also, for cases of septic prepatellar bursitis, antibiotics are used to treat the infection.
· Surgical Management; When conservative treatments have failed for chronic/ post-traumatic knee bursitis, outpatient arthroscopic bursectomy under local anesthesia is an effective procedure.
· Physical therapy management; The Rest, Ice, Compression and Elevation method is commonly used treatment for prepatellar bursitis. The ‘rest-phase’ consists of a short period of immobilization. This period should be limited to the first days after the trauma. Resting will reduce the metabolic demands of the injured tissue and will avoid increased blood flow. The use of ice will cause a decrease of the temperature of the tissues in question, inducing vasoconstriction and a limitation of the bleeding. Also, the pain will decrease because cold will cause increasing threshold levels in the free nerve endings and at synapses. Don’t place the ice too long on your knee (maximum 20 minutes at a time with an interval of 30-60 minutes). The compression will decrease the intramuscular blood flow to the affected area and will also reduce the swelling. At lastly there is the elevation. This ensures that the hydrostatic pressure will decrease and it will also reduce the accumulation of interstitial fluid. This part of the Rice-principle also decreases the pressure in local blood vessels and helps to limit the bleeding. However, the effectiveness of this RICE-method has not been proven in any randomized clinical trial
Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and knee joint. Therapeutic exercises to strengthen and stretch the muscles of the knee. This includes static contraction of the quadriceps. This should be an exercise that the patient can do at home 1 to 3 times a day. The objective of the rehabilitation is that the patient can resume their everyday activities. To see if the exercise is working you have to put your fingers on the inner side of the quadriceps, you will feel the muscle tighten during the contraction of the muscle. The patient has to hold his contraction for 5 seconds; the exercise can be repeated 10 times as hard as possible. It is important not to forget this exercise must be pain-free.
Also, the stretching of the quadriceps is a good exercise for the patient, it reduces the friction between the skin and the patella tendon. There is less friction when the patella tendon is more flexible. The physiotherapist can also help the patient by using electrotherapy modalities and patient education on the use of knee pads for kneeling activities.