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Pes anserine bursitis
From WikEM
Contents
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 Injury
- Knee fractures
- Patella fracture
- Tibial plateau fracture
- Knee dislocation
- Patella dislocation
- Segond fracture
- Meniscus and ligament knee injuries
- Patellar Tendinitis (Jumper's knee)
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Septic Joint
- Gout
- Popliteal cyst (Baker's)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Pes anserine bursitis
- Patellofemoral syndrome (Runner's Knee)
- Patellar Tendinitis (Jumper's knee)
- Osgood-Schlatter disease
- Arthritis
Work-UP
- 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
References
Authors
Ross Donaldson, Claire, Neil Young, Jonathan Osgood, Daniel Ostermayer
