Patient question
Why is the front of my kneecap swollen and painful?
Dr. Pablo GelberOrthopaedic Knee Surgeon
Quick answer
Swelling sitting on top of the kneecap, like a soft cushion, is usually prepatellar bursitis from pressure or a knock. Swelling that fills the whole knee and makes it hard to bend means fluid inside the joint, which needs a different assessment, explains Dr. Pablo Gelber, knee surgeon at Aman Hospital, Doha.
On top of the kneecap or inside the knee?
Look at the knee from the side and compare it with the other one. A bursa swelling is a well-defined, squishy lump directly over the front of the kneecap. You can usually still bend the knee, though kneeling on it hurts.
Joint swelling, often called water on the knee, makes the whole knee look puffy, fills the hollows either side of the kneecap and feels tight when you bend. It points to something inside the joint, such as a meniscus tear, ligament injury, cartilage damage, arthritis or inflammation.
Common causes of each
- Bursitis over the kneecap: repeated kneeling at work or prayer, a fall onto the knee, or friction on hard floors
- Infected bursitis: often after a small cut or graze on the kneecap, with redness, heat and increasing pain
- Joint swelling after injury: a twist in football or padel, especially if it swelled within hours, can mean an ACL tear or bleeding inside the joint
- Joint swelling without injury: arthritis, a degenerative meniscus tear, or inflammatory conditions such as gout
What to do in the first days
For a non-red bursa swelling, avoid kneeling or use thick padding, apply a cold pack for 15 minutes a few times a day, and keep the knee moving. Anti-inflammatory gels may help if they are safe for you. Most cases settle within a few weeks.
For joint swelling after an injury, rest, ice, compression and elevation are reasonable for the first 48 hours, but plan an assessment rather than waiting for it to vanish, because some injuries do better with early treatment.
When it is urgent
Seek same-day care if the swelling is red, hot and increasingly painful, if you have fever or feel unwell, if a cut on the knee is getting angry, or if you cannot bear weight. People with diabetes or reduced immunity should be particularly careful.
Book an appointment if a bursa keeps coming back, or if joint swelling appeared after a twist or returns with activity. At Aman Hospital in Doha, Dr. Gelber examines the knee, may use ultrasound to look at the fluid, and decides whether an MRI or drawing off fluid will help the diagnosis.
Frequently asked questions
Should I squeeze or drain the swelling myself?
No. Puncturing it at home risks introducing infection. If drainage is needed, it is done under sterile conditions after an examination.
Why does the swelling come back every time I kneel?
A bursa that has been irritated stays sensitive to pressure for a while. Padding, reducing time on your knees and occasionally a procedure to remove a persistently troublesome bursa are the options, depending on examination.
Related
