Pes Anserinus Bursitis

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Original Editors - Daan Vandebriel, Glenn Demeyer

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Search Strategy
I first searched the Article Database of the Vrije Universiteit Brussel, further also databases: Web of Knowledge, PubMed, eMedicine, eOrthopod and Science Direct. I used keywords ‘Pes Anserine Bursitis’ or ‘Pes Anserine’ and I started searching for articles who were related to Pes Anserine Bursitis.

Definition/Description

Pes Anserine bursitis as an inflammatory condition of the conjoined insertion of the sartorius, gracilis and semitendinosus. We can locate this at the proximal medial aspect of the knee [15].

Clinically Relevant Anatomy

The Pes Anserine bursa is a fluid filled vesicle with the purpose to secrete synovial fluid and hereby reduce friction between two tissues and also works as a cushion for bones, tendons and muscles [16]. The inflammation of the bursa does not appear suddenly but over an amount of time. You can have bursitis in your shoulder, knee, hip, elbow and your big toe.

The Pes Anserine, also called the ‘Goose Foot’ is the insertion of the Musculus Sartorius, Musculus Gracilis and Musculus Semitendinosus who are conjoined proximal on the medial side of the tibia. The three tendons who are important to the Pes Anserine are located superficial to the Medial Collateral Ligament of the knee. [1] The Sartorius and Gracilis are adductors of the leg (they pull the leg towards the median axis of the body.) and the Semitendinosus is part of the Hamstrings who are located at the back of your upper leg. These three muscles are primarily flexors of the knee and internal rotators. [2]

Epidemiology /Etiology

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Characteristics/Clinical Presentation

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Differential Diagnosis

Pes Anserine bursitis is often confused with other medial knee pain. To start with a stress-fracture of the shinbone on the proximedial side will cause pain in the area of the Pes Anserine. Another example is the patellofemoral syndrome or arthritis. [6,7,8,9] Panniculitis (http://emedicine.medscape.com/article/308694-diagnosis) is something that happens to people who are obese and will cause just like bursitis more pain at night. Semimembranosus tendinitis will often appear after running of cutting activities just like Pes Anserine bursitis. But also the medial plica syndrome which can cause pain and tenderness on the medial side of the knee are often confused with Pes Anserine bursitis.

Diagnostic Procedures

Lateral views of the knee of the patient are very useful to say whether or not out patient has to deal with a stressfracture, arthritis or even Osteochondritis Dissecans. But to be sure that we are not dealing with these injuries we have to take an X-ray. To clarify damage caused to other regions of the medial side of the knee, an MRI is needed. This MRI could prevent you from an unnecessary arthroscopy. Of course you have to correlate the MRI with a physical examination. [10,11] Another procedure is a Lidocaine/Corticosteriod injection in the area of the bursa which will help us determine the contribution of this pathology with the pathology of his overall knee.

Outcome Measures

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Examination

First of all it’s important to examine the tightness of the hamstring. The patient is in the supine position. Then we bend the hip 90° and the knee is straightened as far as possible. How far the knee can be extended will indicate if the Hamstrings are tight or not and how tight they are (If you can straighten your knee completely than your Hamstrings are not tight.).

Medical Management

When someone has Pes Anserine bursitis, surgical intervention is something that doesn’t occur. Only when your patient has to deal with a local infection and the standard antibiotic treatment doesn’t work a surgical decompression of the bursa could be a solution.

Physical Therapy Management

Physiotherapy is the mainstay in the treatment of the Pes Anserine syndrome. To temper the pain that the bursa is causing, the most important thing of all is rest. Take nonsteroidal anti-inflammatory drugs (NSAID) to alleviate the pain, restrict movement, alternate ice (An ice massage of 15 minutes every 4-7 hours will reduce the inflammation.) followed by heat and at last some muscle-conditioning exercises. [12,13,14]

Sometimes people get an injection which consists of a solution of anaesthetic and steroid. Afterwards a physiotherapist will give a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program that has to repeated several times a day. This will result in less pain at about 6-8 weeks.

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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