A bursa is a fluid-filled anatomy that is existent within the tendon, the skin and the bone. The primary role of the bursa is to decrease abrasion in the midst of a contiguous stimulating network (Chatra, 2012). Typecasting of bursae that encompasses the knees can be categorized as those that are present in the area around the patella. Irritation on this fluidfilled anatomy is termed as bursitis (Chatra, 2012). Injury, infection, belabored, and hemorrhage are a part of the mainsprings for irritation.
According to Biundo (2015) other antecedents constitute essential disturbance such as collagen vascular condition and inflammatory arthropathy; in some occurrence the source is unidentified. In acute bursitis, manifestations occur all of a sudden, which, can be a result of infection, particularly the Staphylococcus aureus, or crystalinduced disease (Biundo, 2015). A. Types of bursitis affecting the knees Prepatellar bursitis Inflammation overlying around the patella and the neighboring tissues is known as the prepatellar bursitis.
Derangement in the scheme of lengthened or reworked kneeling advances to hemorrhagic and swollen bursitis (Chatra, 2012). Infrapatellar bursitis Bursitis in the infrapatellar region can be superficial or deep. The region of the superficial infrapatellar bursitis is found in the middle of the tibia tubercle and the superincumbent skin, while the deep infrapatellar bursa is based amongst the distal aspect of the tibia and the patellar tendon (Chatra, 2012). Illiotibial bursitis In the middle of the iliotibial band in proximity to its interpolation on the Gerdy tubercle and the contiguous tibial urface lays the iliotibial bursa. Bursitis of the iliotibia and inflammation of the tendons is commonly in arrears to belabor and varus stress on the knees (Chatra, 2012). Pes anserine bursitis The pes anserine bursa detaches the pes anserine tendons that inhere to the distal sartorius gracilis and semitendinosus tendons, from the underlying tibial collateral ligament and the bony exterior of the medial tibial condyle. They are minute in size; they do not expand into the thighs and do not present articulation with the joints in the knees (Chatra, 2012).
Causes of acute bursitis in the knees Injury, infection, belabored, and hemorrhage are a part of the mainsprings for irritation. Other antecedents constitute essential disturbance such as collagen vascular condition and inflammatory arthropathy; in some occurrence the source is unidentified. In acute bursitis, manifestations occur all of a sudden, which, can be a result of infection, particularly the Staphylococcus aureus or crystal-induced disease (Biundo, 2015). B. Target population
In the occurrence of acute bursitis, inadequacy of the anterior cruciate ligament (ACL), insufficiency of the menisci, and the maladjustment of the tibiofemoral and the patellofemoral compartments must be directed. Knee insults in the intraarticular site are incessantly found in the athletic populace. This may proceed into deteriorating knee insults (Flanigan, Harris, Trinh, Siston & Brophy, 2010). C. Goal of management The therapeutic objectives are to distinguish the source of the inflammation, decrease the swelling, restore the surface of the bursa to inhibit the thickening of the bursa.
Proof without certainty in septic bursitis must be intervened with antibiotics while anticipating for culture results. Oral antibiotics are the treatment for the occurrence of septic bursitis (Lohr, 2015). Aspiration and drainage associated with padding and guarding are the interventions preferred for acute bursitis in the knees. Presence of systemic symptoms in immunocompromised patients may benefit from intravenous (IV) intervention. When patients who do not act in response to these interventions may need to have surgery (Lohr, 2015).
Prevalence of acute bursitis in the knees of athletes Athletes who engage in sports in which forthright blow or fall on the knees are prevalent and this includes football, basketball or wrestling, or basketball, are at greater risk of the situation. Bursitis in the prepatellar region for athletes can also be due to a bacterial septicity (Orthopaedic surgeons, 2015). When the integrity of the skin is compromised because of a knee insult from an insect bite, scrape or from a perforated wound, bacteria may enter the bursal sac and instigate an infection (Orthopaedic surgeons, 2015).
Complications of acute bursitis in the knees of athletes Common complexity in acute bursitis of the knees in athletes is septicemia and osteomyelitis. It can be present in septic bursitis especially when the situation presents a delay or the diagnosis is not pronounced. Unrelenting pain and combined reduced practical usage may be due to the illness mechanism in unruly cases. Periodic incidence of acute bursitis can develop into a chronic arthritic disease (Glencross, 2015). Diagnosis of acute bursitis in the knees of athletes
In acute bursitis of the knees it is crucial to procure bursa aspirate to preclude infectious origin of a prepatellar bursitis. When the test outcome for infectious bursitis is known, a culture and sensitivity are implemented to exhibit a fitting antibiotic intervention (Glencross, 2015). In rare cases when potential infection is known, other studies such as radiography, radionuclide bone scanning, rheumatologic testing and rheumatoid factor measurement must be examined (Glencross, 2015). Treatment of acute bursitis in the knees of athletes
Reduction of pain and inflammation in the bursa of the knees is the intended objective of treatment and determining and managing the primary reason of the deviated gait. Constraint in the physical activity, preservation of the knees, and ice are preferred interventions for acute bursitis (Mayoclinic, 2015). In anserine bursitis, the preferred intervention is the glucocorticoid injections and when bursitis perplexes one of the articular disorders, intervention must be directed on the primary cause (Glencross, 2015).
Patient education including resources Appropriate means of intervention in acute occurrences includes education on the amount of time needed to allow sufficient time for rest. It is necessary that the importance of proper exercises be emphasized to restore the strength of the muscles involved. Interventions to help athletes comprises the involvement of coaches and trainers, they must be taught regarding a slow increase in the activity level and duration of the patient’s signs and symptoms (Glencross, 2015). Role of Nurse Practitioners’ in managing acute bursitis of the knees in athletes
The Nurse Practitioner (NP) initially identifies the cause of the condition after the outset of symptoms. The NP in a primary care setting takes the complete history and physical examination of the patient and identifies whether it is an acute onset of the bursitis in the knees or chronic. Prevention is the mainstay of any condition and it is the NP’s duty to educate patients about the importance in avoiding acute bursitis in their lifetime. The interventions procured must be directed towards the main goal in the treatment of acute bursitis.
The patient’s safety and well being is the utmost objective in managing acute bursitis. Conclusion A thorough history and physical examination can significantly determine the cause of acute bursitis in the knees of athletes. Educating and implementing proper management of the condition can prevent complications that can further damage the patella. Promoting consciousness that acute bursitis is invertible can lead to reduce deterioration to the affected knee. Family nurse practitioners can help decrease the incidence of complications by diagnosing the condition appropriately to prevent hospital admissions.
