Pes anserine bursitis: Difference between revisions

Latest revision as of 19:47, 31 August 2022

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

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

Nontraumatic/Subacute

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

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+[[File:Pes anserinus.png|thumb|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
+*Osteoarthritis of knee
-#Obese females
+*Obese females
-#History of athletic activity (overuse)
+*History of athletic activity (overuse)
-##E.g. runners
+**e.g. runners
-==Diagnosis==
+{{Tendinopathy types}}
-#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
-==DDX==
+==Clinical Features==
-#Hamstring Strain
+*Anterior medial knee pain, frequently chronic (insertion of pes anserine)
-#Medial Collateral and Lateral Collateral Ligament Injury
+*Worse with ascending stairs and when arising from a seated position
-#Myofascial Pain
+*Focal swelling occasionally noted over the bursa
-#Osteoarthritis
+*TTP over the bursa
-#Patellofemoral Syndrome
-#Prepatellar Bursitis
-#Stress Fracture
-#Fibromyalgia
-==Work-UP==
+==Differential Diagnosis==
-*Consider knee x-rays to r/o fx
+{{Knee DDX}}
-**Frequently NOT indicated
-==Treatment==
+==Evaluation==
-#RICE
+*Consider knee x-rays to rule out fracture
-#NSAIDS
+**Frequently NOT indicated. See [[Ottawa Knee Rules]]
-#Physical Therapy
-#Intrabursal injection with local anesthetics and/or corticosteroids (second line treatment)
+==Management==
-##3-5 mL of 1% lidocaine with or without methylprednisolone into point of maximal tenderness in bursa
+*RICE
-###Do not inject actual tendons themselves.
+*[[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
+*Home
-##Admit for IV abx if infected bursa is suspected
+*Admit for IV antibiotics if [[septic bursitis|infected bursa]] is suspected
-#Follow up PMD +/- Physical Therapy
+*Follow up with primary care provider +/- Physical Therapy
 ==See Also==
-*[[Knee (Minor)]]
+*[[Knee diagnoses]]
+==References==
+<references/>
-==Source==
-*Tintinalli
-[[Category:Ortho]]
+[[Category:Orthopedics]]
+[[Category:Sports Medicine]]