Pes anserine bursitis

Background

• Name comes from proximity to the pes anserine (three tendons that insert on the tibia)
• Inflammatory condition of the medial knee

Risk Factors

1. Osteoarthritis of knee
2. Obese females
3. History of athletic activity (overuse)
   1. E.g. runners

Diagnosis

1. Anterior medial knee pain, frequently chronic (insertion of pes anserine)
   1. Worse with ascending stairs and when arising from a seated position
2. Focal swelling occasionally noted over the bursa
3. TTP over the bursa

DDX

1. Hamstring Strain
2. Medial Collateral and Lateral Collateral Ligament Injury
3. Myofascial Pain
4. Osteoarthritis
5. Patellofemoral Syndrome
6. Prepatellar Bursitis
7. Stress Fracture
8. Fibromyalgia

Work-UP

• Consider knee x-rays to r/o fx
  • Frequently NOT indicated

Treatment

1. RICE
2. NSAIDS
3. Physical Therapy
4. Intrabursal injection with local anesthetics and/or corticosteroids (second line treatment)
   1. 3-5 mL of 1% lidocaine with or without methylprednisolone into point of maximal tenderness in bursa
      1. Do not inject actual tendons themselves.

Disposition

1. Home
   1. Admit for IV abx if infected bursa is suspected
2. Follow up PMD +/- Physical Therapy

See Also

• Knee (Minor)

Source

• Tintinalli