Pes anserine bursitis

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Background

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

Risk Factors

  • Osteoarthritis of knee
  • Obese females
  • History of athletic activity (overuse)
    • e.g. runners

Evaluation

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

Differential Diagnosis

Knee diagnoses

Acute knee injury

Nontraumatic/Subacute

Work-UP

  • Consider knee x-rays to rule out fracture

Management

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

Disposition

  • Home
  • Admit for IV antibiotics if infected bursa is suspected
  • Follow up with primary care provider +/- Physical Therapy

See Also

References