Stephen Bird

Hi Mike,

There are a few options here,

It is certainly an inflammatory condition.

The sub-cutaneous fat is really echogenic and you report that the knee is swollen, red and warm.

I agree there is increased vascularity n the quadriceps tendon and the tendon itself is more echogenic than I would expect.

The knee joint does NOT appear to have any effusion and it might be worth putting a power Doppler box into the supra patellar pouch to see if there is any knee joint synovitis. The absence of a knee joint effusion makes my think primary knee synovitis is unlikely.

So that leaves us with things that cause inflammation in the sub-cutaneous tissues superficial to the knee joint.

Pre patellar bursitis
Anything else you can think of?

I include gout as this would explain the involvement of the quad tendon.

You could do some bloods

I can’t see anything that is aspiratable at this stage.


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