Pes anserine bursitis: Difference between revisions

Latest revision as of 19:47, 31 August 2022

Background

Muscles of the gluteal and posterior femoral regions. Area of pes anserinus (circled); sartorius, gracilis, semitendinosus and semimembranosus are labeled (bottom).

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

Tendinopathy Types

Clinical Features

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 knee injury

Nontraumatic/Subacute

Evaluation

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

References

Authors:

@@ Line 1: / Line 1: @@
-===Background===
+==Background==
+[[File:Pes anserinus.png|thumb|Muscles of the gluteal and posterior femoral regions. Area of pes anserinus (circled); sartorius, gracilis, semitendinosus and semimembranosus are labeled (bottom).]]
 *Name comes from proximity to the pes anserine (three tendons that insert on the tibia)
-*Commonly seen in obese women w/ OA, in runners, and in pts w/ overuse syndrome
+*Inflammatory condition of the medial knee
-===Clinical Features===
+===Risk Factors===
-*Anterior medial pain
+*Osteoarthritis of knee
-*Focal swelling may be noted over the bursa
+*Obese females
-*TTP over the bursa
+*History of athletic activity (overuse)
+**e.g. runners
-===Treatment===
+{{Tendinopathy types}}
-*NSAIDs, rest, heat
-*Admit for IV abx if infected bursa is suspected
-==See Also==
+==Clinical Features==
-*[[Knee (Minor)]]
+*Anterior medial knee pain, frequently chronic (insertion of pes anserine)
+*Worse with ascending stairs and when arising from a seated position
-==Source==
+*Focal swelling occasionally noted over the bursa
-*Tintinalli
+*TTP over the bursa
-[[Category:Ortho]]
+==Differential Diagnosis==
+{{Knee DDX}}
-==Background==
+==Evaluation==
-*Also known as Pes Anserine Bursitis
+*Consider knee x-rays to rule out fracture
-*Inflammatory condition of the medial knee
+**Frequently NOT indicated. See [[Ottawa Knee Rules]]
-**Insertion of sartorius muscle
-===Risk Factors===
+==Management==
-#Arthritis of knee
+*RICE
-#Obese females
+*[[NSAIDS]]
-#History of athletic activity (chronic use)
+*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.
-==Diagnosis==
+==Disposition==
-#Pain, frequently chronic
+*Home
-#Tenderness over the medial knee (insertion of pes anserine)
+*Admit for IV antibiotics if [[septic bursitis|infected bursa]] is suspected
-##Worse with ascending stairs and when arising from a seated position
+*Follow up with primary care provider +/- Physical Therapy
-#Local swelling (occasionally)
-==DDX==
+==See Also==
-#Hamstring Strain
+*[[Knee diagnoses]]
-#Medial Collateral and Lateral Collateral Ligament Injury
-#Myofascial Pain
-#Osteoarthritis
-#Patellofemoral Syndrome
-#Prepatellar Bursitis
-#Stress Fracture
-#Fibromyalgia
-==Work-UP==
+==References==
-*Consider knee x-rays to r/o fx
+<references/>
-**Frequently NOT indicated
-==Treatment==
-#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
-#Follow up PMD +/- Physical Therapy
-[[Category:Ortho]]
+[[Category:Orthopedics]]
+[[Category:Sports Medicine]]