Ask the doctor: Housemaid's knee? Don't let your GP go near it!

Dr Martin Scurr has been treating patients for more than 30 years and is one of the country's leading GPs. Here he tackles housemaid's knee and polycystic ovaries...

I’m 47 and have always been fit and healthy, but a few months ago I developed a large swelling on my right knee. The doctor diagnosed bursitis (or housemaid's knee). Resting it didn’t help, so she drained it and gave me a steroid injection.

I’ve now had this done three times, but the swelling remains. I then saw an orthopaedic specialist who suggested surgery. Both the doctor and specialist said the swelling is not harmful and it doesn’t hurt, although it tingles when I’ve been walking a lot. Is an operation absolutely necessary? Ruth Elaine Power, Merthyr Tydfil, Wales.

Dr Scurr says... Housemaid's knee is actually one of two types of swelling you can develop at the front of the knee. The other is known as clergyman’s knee. Both are painless, fluid-filled swellings (the size of a squashy tangerine) which develop as a result of a minor injury. The difference between them is simply in their location.

If the swelling is in front of the kneecap, it’s called housemaid’s knee. These days, thanks to Hoovers and other modern gadgets few cleaning ladies develop it. However it’s an occupational hazard for those who do a lot of kneeling, such as floor tile layers or carpet fitters.

When the swelling occurs just below the kneecap, over the patellar tendon, it is called clergyman’s knee - probably because that’s where you apply pressure when kneeling at prayer.

Housemaid's knee pic

Housemaid's knee: It's one of two types of swelling you can develop on the front of the knee

Both are quite harmless and can be left alone. They are also very common - I probably see one every week. Officially the condition is called bursitis. Small sacs of fluid - or bursa - are found naturally around the joints.

Their job is to help reduce friction and give the joint flexibility. But if the area becomes damaged, the bursa swells with increased in fluid in the sac, leading to bursitis.

It is always tempting for a doctor to draw the fluid off through a needle - we like doing those craft-based techniques which we so often did as hospital doctors during our training.

But the swelling usually reappears within days because the fluid is the body’s way of cushioning a vulnerable bony point, and unless the irritation is reduced it will go on trying to protect the area.

Adding cortisone after removing the fluid might help prevent recurrence, but as you found, it is not always effective.

And the risk of doing this is that the needle opens a highway for germs, and the swelling can become infected. It can then take weeks of antibiotic treatment to settle the whole mess down. Even then, the bursa will remain. Infection can also occur spontaneously.

Surgery means a keyhole operation to remove the fluid-filled sac. The joint can function without the bursa. However, I think a sensible approach is to do nothing.

These swellings often remain for a year or two and then slowly subside, eventually disappearing.

It is well worth waiting if you can bear the unsightly appearance. And certainly do all you can to keep off your knees.

Several months ago, I was diagnosed with polycystic ovaries. I’m 43 and had irregular periods and stopped ovulating. I was prescribed metformin (a diabetic drug) to reduce my blood sugar levels for four months, then my doctor said my the hormone levels had improved, so I should stop.

I am confused as to whether that means I am now cured and, if so, whether it will come back, how a diabetic drug works for this condition and how I know if I'm ovulating now. Jo Cook, Farnborough.

Dr Scurr says... This is a confusing subject for doctors so it does not surprise me that you are feeling confused.

Polycystic ovaries are a common problem affecting around 20-30 per cent of women, although not everyone has the full blown condition - polycystic ovary syndrome (PCOS).

This leads to irregular ovulation, and so to irregular or even no menstruation at all. The cause is unknown, although there is a genetic link.

Women with this condition have larger than usual ovaries, which can contain up to 12 or more follicles (cysts). On scans these look like a string of pearls.

The symptoms of PCOS include irregular periods, acne, excessive weight gain, and excess body and facial hair - the latter are the result of an imbalance in hormones (basically you end up with too much of the male hormone testosterone).

The worry for a woman with PCOS is that it reduces her fertility, although the tendency to obesity can mean that there is also an increased risk of heart disease and diabetes.




Some women have only mild symptoms - maybe they have just rather irregular periods. Others suffer more severe problems.

The treatment therefore is focused on the individual symptoms, although the key is to restore regular ovulation.

Because obesity affects the hormone balance anyway, when combined with polycystic ovaries it makes problems even worse. So women are encouraged to lose weight to help kickstart ovulation.

The anti-diabetic drug metformin can also help. It does this by increasing insulin levels and so improving the way you process sugar (which in turn improves your hormone balance). Contrary to popular belief, the drug won’t help you lose weight. It’s important to understand that polycystic ovarian syndrome can be managed, but not cured.

What all of this means in your case is not clear as I don’t have the full picture. However, a regular menstrual cycle over the next few months will mean that you are ovulating. This is vital only if you are hoping to become pregnant.

If this is not an issue, the good news is that when you reach the menopause, the ovaries stop functioning anyway, and all the abnormal hormone secretions will just fade away.

By the way...


A bill o promote sex education and contraception could well fail in The Philippines

In The Philippines, which is staunchly Catholic, a parliamentary bill to promote sex education and the use of contraceptives may fail because of opposition from the Church - despite the hope that the bill will reduce poverty by helping to control the rise in population and the incidence of sexually transmitted infections.

You might think it unlikely the Church would interfere in similar medical matters in this country. Yet two years ago the Pope (pictured right) opposed the arrival of an NHS general practice in the grounds of the Hospital of St John & Elizabeth in St John’s Wood, London.

The hospital already conducts many NHS activities, and most of the doctors are not Catholics. Most of the patients are not Catholics, either. Yet all the care given there is guided by Catholic moral ethics teaching.

This means that giving advice about contraception is forbidden - somewhat of a problem for GPs who are compelled to put the well-being of their patients ahead of their own personal philosophy.

Why did this matter? The NHS general practice provides excellent medical care to 11,000 members of the local community.

And yet its very survival was threatened by a highly religious faction concerned about the offence it would cause to the Catholic community.

Who is that Catholic community? Certainly the Catholic families in my practice are no different from any others when it comes to producing children - despite the teaching of the Church, which permits only ‘natural’ family planning, they are clearly using other methods. How else can they be limiting their children to just two or three?

Is the hierarchy of the Church in touch with the congregation? Somehow I sense not.
What most people want is good health care without prejudice, Catholic, Islamic or otherwise. We doctors call it the Hippocratic Oath.



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