We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Pes Anserine Bursitis

From WikiSM
Jump to: navigation, search


Other Names

  • Pes Anserine Pain Syndrome (PAPS)
  • Anserine bursitis
  • Pes Anserine Pain
  • Pes Anserinus Tendinitis or Bursitis (PATB)

Background

  • This page refers to inflammation of the pes anserine bursa, commonly referred to as pes anserine tendinitis or bursitis (PATB)

History

Epidemiology

  • Poorly described in the literature

Pathophysiology

  • Mechanical Derangement
  • Overuse
    • Thought to be due to repetitive flexion, adduction
  • Other implicated etiologies
    • Direct trauma
    • Obesity

Pathoanatomy

Associated Conditions


Risk Factors


Differential Diagnosis


Clinical Features

  • History
    • Medial knee pain
    • Worse with standing, stairs, crossing leg
    • Subjective weakness, diminished range of motion
  • Physical Exam
    • Swelling may or may not be present
    • Tenderness over the pes anserine at the medial, proximal tibia, with knee at 90°
    • In extension, tenderness may be over medial joint line
    • Pain with resisted internal rotation and flexion of the knee
    • Location: 3-4 cm medial to tibial tubercle, 3 cm below anteromedial tibial platea
  • Special Tests

Pes Anserine bursitis with fluid in the bursa seen in long axis (arrow)[4]

Evaluation

Radiographs

Ultrasound

  • Findings
    • Swelling
    • Bursal fluid
    • Thickened pes anserine, especially in patients with knee OA[5]

MRI

  • Not typically indicated
  • Findings[6]
    • Increased bursal fluid
    • Thickened bursal wall
    • Surrounding tissue edema
    • Abnormal wall / surrounding tissue enhancement

Classification

  • Not applicable

Management

Nonoperative

  • Indication
    • Vast majority of cases
  • When appropriate, treatment should be directed at underlying etiology
    • For example, osteoarthritis
  • Relative rest
  • Activity modification
  • NSAIDS
  • Weight Loss
  • Physical Therapy
    • Emphasis on strengthening quadriceps muscles
  • Corticosteroid Injection
    • One small study showed potential benefit[7]
    • Consider an intra-articular injection for knee OA + intra-bursa injection for pes anserine pain

Operative

  • Indications
    • Rarely, failure of conservative treatment
  • Technique
    • Bursal incision and drainage
    • Bursectomy

Rehab and Return to Play

Rehabilitation

  • Emphasis on
    • Closed kinetic chain exercises

Return to Play

  • No clear return to play guidelines

Complications & Prognosis

Prognosis

  • Needs to be updated

Complications

  • Chronic pain
  • Inability to return to sport

See Also


References

  1. Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care. 2018 Jun;45(2):289-303.
  2. Alvarez-Nemegyei J, Peláez-Ballestas I, Goñi M, et al. Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria. Clin Rheumatol. 2016 Jul;35 Suppl 1:63-70.
  3. Sapp GH, Herman DC. Pay Attention to the Pes Anserine in Knee Osteoarthritis. Curr Sports Med Rep. 2018 Feb;17(2):41.
  4. Image courtesy of ultrasoundcases.info, "Pes anserinus tendons"
  5. Toktas, Hasan, et al. "Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis." Modern rheumatology 25.1 (2015): 128-133.
  6. Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology. 194 (2): 525-7.
  7. Yoon HS, Kim SE, Suh YR, Seo YI, Kim HA. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci. 2005 Feb;20(1):109-12.
Created by:
John Kiel on 10 June 2019 17:09:49
Authors:
Last edited:
11 January 2022 19:37:57
Categories: