The prepatellar bursa lies between the skin and the anterior surface of the patella, allowing the skin to move freely over the kneecap during kneeling.
Prepatellar bursitis ('housemaid's knee') is caused by prolonged kneeling and produces a painless, fluctuant swelling directly over the patella. Septic bursitis must be distinguished from aseptic by aspiration and fluid analysis.
Fluid-filled swelling directly over the patella from repetitive friction — generally painless unless infected, when redness, warmth, and systemic features suggest septic bursitis requiring aspiration and antibiotics.
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