Pes anserine bursitis

Background

Muscles of the gluteal and posterior femoral regions. Area of pes anserinus (circled); sartorius, gracilis, semitendinosus and semimembranosus are labeled (bottom).

• 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

Tendinopathy Types

• Patellar tendonitis
• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golf elbow)
• Pes anserine bursitis

Clinical Features

• 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

• Knee dislocation
• Knee fractures
  • Patella fracture
  • Segond fracture
  • Tibial plateau fracture
• Meniscus and ligament knee injuries
• Patella dislocation
• Patellar tendonitis
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Arthritis
• Gout and Pseudogout
• Osgood-Schlatter disease
• Patellofemoral syndrome (Runner's Knee)
• Patellar tendonitis (Jumper's knee)
• Pes anserine bursitis
• Popliteal cyst (Bakers cyst)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Septic joint
• DVT

Evaluation

• Consider knee x-rays to rule out fracture
  • Frequently NOT indicated. See Ottawa Knee Rules

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

• Knee diagnoses