Pes anserine bursitis: Difference between revisions
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==Background== | ==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) | *Name comes from proximity to the pes anserine (three tendons that insert on the tibia) | ||
*Inflammatory condition of the medial knee | *Inflammatory condition of the medial knee | ||
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**e.g. runners | **e.g. runners | ||
== | {{Tendinopathy types}} | ||
==Clinical Features== | |||
*Anterior medial knee pain, frequently chronic (insertion of pes anserine) | *Anterior medial knee pain, frequently chronic (insertion of pes anserine) | ||
*Worse with ascending stairs and when arising from a seated position | *Worse with ascending stairs and when arising from a seated position | ||
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{{Knee DDX}} | {{Knee DDX}} | ||
== | ==Evaluation== | ||
*Consider knee x-rays to | *Consider knee x-rays to rule out fracture | ||
**Frequently NOT indicated. See [[Ottawa Knee Rules]] | **Frequently NOT indicated. See [[Ottawa Knee Rules]] | ||
==Management== | ==Management== | ||
*RICE | *RICE | ||
*NSAIDS | *[[NSAIDS]] | ||
*Physical Therapy | *Physical Therapy | ||
*Intrabursal injection with local anesthetics and/or corticosteroids (second line treatment) | *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 | **3-5 mL of 1% [[lidocaine]] with or without [[methylprednisolone]] into point of maximal tenderness in bursa | ||
**Do not inject actual tendons themselves. | **Do not inject actual tendons themselves. | ||
==Disposition== | ==Disposition== | ||
*Home | *Home | ||
*Admit for IV | *Admit for IV antibiotics if [[septic bursitis|infected bursa]] is suspected | ||
*Follow up | *Follow up with primary care provider +/- Physical Therapy | ||
==See Also== | ==See Also== | ||
*[[Knee | *[[Knee diagnoses]] | ||
==References== | ==References== | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 19:47, 31 August 2022
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
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
- 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