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Pes Anserine Bursitis

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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

  • In a large Mexican population, the incidence was 0.34% among 13,000 surveyed individuals[1]
  • Another study found a prevalence of 0.54% in males and 0.7% in females[2]

Pathophysiology

Illustration of the pes anserinus
  • Inflammation
    • Historically, thought to cause local inflammation to surrounding tendinous structures
    • Includes Medial Meniscus, Medial Collateral Ligament which may irritate pes anserine bursa
    • Studies rarely show inflammation of the bursa[3]
  • Overuse leading to tendinopathy
    • Thought to be due to repetitive flexion, adduction
    • Some authors suggest semitendinosus is the most common culprit
  • Other implicated etiologies
    • Direct trauma
    • Obesity

Pathoanatomy

Associated Conditions

Pediatric Considerations

  • Rare in skeletally immature pediatric patients
  • Consider physical fracture in the setting of medial tibial pain

Risk Factors

  • Sports[6]
    • Running
    • Basketball
    • Basketball
    • Racquet Sports
    • Racquet sports
  • Other

Differential Diagnosis

Palpation of pes bursa and associated pes anserine tendons. Note knee is flexed to 90°[7]

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
    • No tests specific to Pes Anserine
Pes Anserine bursitis with fluid in the bursa seen in long axis (arrow)[8]

Evaluation

Radiographs

Ultrasound

  • Findings
    • Swelling
    • Bursal fluid
    • Thickened pes anserine, especially in patients with knee OA[9]

MRI

  • Not typically indicated
  • Findings[10]
    • 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
    • Also if indicated, core, gluteal, short hip rotator strengthening
  • Corticosteroid Injection
    • One small study showed potential benefit[11]
    • 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

External

References

  1. ↑ Alvarez-Nemegyei, Jose, et al. "Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria." The Journal of Rheumatology Supplement 86 (2011): 15-20.
  2. ↑ Alvarez-Nemegyei, José, 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." Clinical rheumatology 35 (2016): 63-70.
  3. ↑ Uson, J., et al. "Pes anserinus tendino-bursitis: what are we talking about?." Scandinavian journal of rheumatology 29.3 (2000): 184-186.
  4. ↑ Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care. 2018 Jun;45(2):289-303.
  5. ↑ 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.
  6. ↑ Sapp GH, Herman DC. Pay Attention to the Pes Anserine in Knee Osteoarthritis. Curr Sports Med Rep. 2018 Feb;17(2):41.
  7. ↑ Cowles, Larry M., and Anthony I. Beutler. "Pes Anserine Pain Syndrome." Common Pediatric Knee Injuries: Best Practices in Evaluation and Management (2021): 207-216.
  8. ↑ Image courtesy of ultrasoundcases.info, "Pes anserinus tendons"
  9. ↑ 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.
  10. ↑ Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology. 194 (2): 525-7.
  11. ↑ 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
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Last edited:
13 March 2023 01:18:04
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