eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Pes Anserinus Bursitis: Follow-up

Author: P Mark Glencross, MD, MPH, FACOEM, FAAPMR, Occupational and Environmental Medicine, Physical Medicine and Rehabilitation, President of Florida Occupational and Environmental Medicine Consultants (FOEMC)
Contributor Information and Disclosures

Updated: Sep 10, 2009

Follow-up

Further Outpatient Care

  • Patients with pes anserine bursitis generally are treated successfully with conservative measures and are recommended to receive outpatient physical therapy (see Physical Therapy for treatment recommendations).

Prognosis

  • Surgical intervention for pes anserine bursitis is required only rarely. Rest, administration of NSAIDs, or injection brings about resolution in most cases. Chronic arthritic diseases that frequently accompany bursitis obviously persist, but identification and treatment of pes anserine bursitis can significantly reduce pain. Most athletes return to play sports.

Patient Education

  • Patients with pes anserine bursitis need to be educated in the proper means of treatment and, in acute cases, need to allow adequate time for rest.
  • Patients need to learn about the importance of exercise to rebuild the involved muscles, so that older individuals with arthritis can avoid disuse atrophy. A home exercise program may be provided by the physical therapist.
  • For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Arthritis Center. Also, see eMedicine's patient education articles Bursitis, Knee Pain, and Knee Injury.

Miscellaneous

Medicolegal Pitfalls

  • Clinically, pes anserine bursitis can mimic distal anteromedial knee disorders or internal derangement of the knee, leading to unnecessary surgery. In an investigation of 509 MRI studies on individuals who were thought to have an internal knee derangement, the prevalence of pes anserine bursitis was found to be 2.5%.14

Special Concerns

  • Further clarification of the predisposing conditions for pes anserine bursitis is needed, including its mechanical causes and specific pathologic variants. Medical literature continues to report underrecognition of this disorder as a cause for medial knee pain in various groups of patients.
  • A few reports have questioned the frequency of pes anserine bursitis and its accepted pathophysiology, given the lack of ultrasonographic findings. In one study, only 3 of 29 patients with suspected pes anserine tendinobursitis were found to have tendinitis on ultrasonographic images when compared with the uninvolved extremity or healthy controls. In a study of patients with type 2 diabetes mellitus, 4 out of 14 patients who were clinically diagnosed with pes anserine tendinobursitis syndrome were found to have ultrasonographically apparent morphologic changes in the pes anserine tendons.15
 
Acknowledgments

We wish to acknowledge Dr. James P Little for his previous contribution to this article.



More on Pes Anserinus Bursitis

Overview: Pes Anserinus Bursitis
Differential Diagnoses & Workup: Pes Anserinus Bursitis
Treatment & Medication: Pes Anserinus Bursitis
Follow-up: Pes Anserinus Bursitis
Multimedia: Pes Anserinus Bursitis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Wood LR, Peat G, Thomas E, et al. The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults. Osteoarthritis Cartilage. Jun 2008;16(6):647-53. [Medline].

  2. Moschowitz E. Bursitis of sartorius bursa, an undescribed malady simulating chronic arthritis. JAMA. 1937;109:1362.

  3. Cohen SE, Mahul O, Meir R, et al. Anserine bursitis and non-insulin dependent diabetes mellitus. J Rheumatol. Nov 1997;24(11):2162-5. [Medline].

  4. Alvarez-Nemegyei J. Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study. J Clin Rheumatol. Apr 2007;13(2):63-5. [Medline].

  5. Maheshwari AV, Muro-Cacho CA, Pitcher JD Jr. Pigmented villonodular bursitis/diffuse giant cell tumor of the pes anserine bursa: a report of two cases and review of literature. Knee. Oct 2007;14(5):402-7. [Medline].

  6. Hepp P, Engel T, Marquass B, et al. Infiltration of the pes anserinus complex by an extraarticular diffuse-type giant cell tumor (D-TGCT). Arch Orthop Trauma Surg. Feb 2008;128(2):155-8. [Medline].

  7. Marra MD, Crema MD, Chung M, et al. MRI features of cystic lesions around the knee. Knee. Dec 2008;15(6):423-38. [Medline].

  8. Hemler DE, Ward WK, Karstetter KW, et al. Saphenous nerve entrapment caused by pes anserine bursitis mimicking stress fracture of the tibia. Arch Phys Med Rehabil. Apr 1991;72(5):336-7. [Medline].

  9. Voorneveld C, Arenson AM, Fam AG. Anserine bursal distention: diagnosis by ultrasonography and computed tomography. Arthritis Rheum. Oct 1989;32(10):1335-8. [Medline].

  10. Yoon HS, Kim SE, Suh YR, et al. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci. Feb 2005;20(1):109-12. [Medline].

  11. Uson J, Aguado P, Bernad M, et al. Pes anserinus tendino-bursitis: what are we talking about?. Scand J Rheumatol. 2000;29(3):184-6. [Medline].

  12. Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology. Feb 1995;194(2):525-7. [Medline]. [Full Text].

  13. Zeiss J, Coombs RJ, Booth RL Jr, et al. Chronic bursitis presenting as a mass in the pes anserine bursa: MR diagnosis. J Comput Assist Tomogr. Jan-Feb 1993;17(1):137-40. [Medline].

  14. Rennie WJ, Saifuddin A. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal Radiol. Jul 2005;34(7):395-8. [Medline].

  15. Unlu Z, Ozmen B, Tarhan S, et al. Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus. J Rheumatol. Feb 2003;30(2):352-4. [Medline].

  16. Abeles M. Anserine bursitis. Arthritis Rheum. Jun 1986;29(6):812-3. [Medline].

  17. Handy JR. Anserine bursitis: a brief review. South Med J. Apr 1997;90(4):376-7. [Medline].

  18. Katzenstein PL, Malemud CJ, Pathria MN, et al. Early-onset primary osteoarthritis and mild chondrodysplasia. Radiographic and pathologic studies with an analysis of cartilage proteoglycans. Arthritis Rheum. May 1990;33(5):674-84. [Medline].

  19. Larsson LG, Baum J. The syndrome of anserina bursitis: an overlooked diagnosis. Arthritis Rheum. Sep 1985;28(9):1062-5. [Medline].

  20. Muchnick J, Sundaram M. Radiologic case study. Pes anserine bursitis. Orthopedics. Nov 1997;20(11):1100; 1092-4. [Medline].

  21. Sheon RP, Moskowitz RW, Goldberg VM. Soft Tissue Rheumatic Pain: Recognition, Management, and Prevention. 3rd ed. Baltimore, Md: Lippincott William & Wilkins; 1996:236-7.

  22. Larson RL, Grana WA, eds. The Knee: Form, Function, Pathology, and Treatment. Philadelphia, Pa: WB Saunders; 1993:327-9.

  23. Windsor RE, Lox DM. Soft Tissue Injuries: Diagnosis and Treatment. Philadelphia, Pa: Hanley & Belfus; 1998:118-9.

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics:
 Bursitis [Emergency Medicine]
Bursitis [Orthopedic Surgery]
Knee, Extensor Mechanism Injuries (MRI)
Knee, Collateral Ligament Injuries (MRI)
Pes Anserine Bursitis [Sports Medicine]

[ CLOSE WINDOW ]

Keywords

pes anserinus bursitis, pes anserine bursitis, knee pain, bursitis, bursa, tendinitis, tendonitis, knee swelling, bursitis knee, pes anserinus, bursitis treatment, bursitis symptoms, bursitis pain, bursitis therapy, sartorius, gracilis, pes anserine, sartorius muscle, semitendinosus, bursitis knee, bursae, bursitis of the knee, bursitis exercise, anserine bursitis syndrome, conjoined tendon, breaststroker's knee, pes anserinus tendino-bursitis, pes anserinus tendinobursitis, pes anserinus tendino-bursitis syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

P Mark Glencross, MD, MPH, FACOEM, FAAPMR, Occupational and Environmental Medicine, Physical Medicine and Rehabilitation, President of Florida Occupational and Environmental Medicine Consultants (FOEMC)
P Mark Glencross, MD, MPH, FACOEM, FAAPMR is a member of the following medical societies: Air Medical Physician Association, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, Florida Association of Occupational and Environmental Medicine, Florida Society of Physical Medicine and Rehabilitation, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.