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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
Authors:
Last edited:
13 March 2023 01:18:04
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