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Pes Anserine Bursitis Medication

  • Author: P Mark Glencross, MD, MPH, FACOEM, FAAPMR; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: May 10, 2016
 

Medication Summary

In general, medications are not frequently used to treat pes anserine bursitis. In cases where pharmacologic therapy may be warranted to help alleviate symptoms, the addition of an over-the-counter or prescribed anti-inflammatory medication, such as a nonsteroidal anti-inflammatory drug (NSAID), may be indicated. In addition, injection of a local anesthetic, with or without a corticosteroid, may be helpful.

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Nonsteroidal Anti-inflammatory Drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Although increased cost can be a negative factor, the incidence of costly and potentially fatal gastrointestinal (GI) bleeding is clearly lower with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of the cost of preventing GI bleeding will further define the populations that will find COX-2 inhibitors the most beneficial.

Anesthetic (local) and corticosteroid combinations may be used. Local anesthetics stabilize neuronal membranes and prevent the initiation and transmission of nerve impulses, thereby producing local anesthesia. Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects; in addition, they modify the body’s immune response to diverse stimuli. This compounded medication consists of 0.5 mL of betamethasone and 2.0 mL of 1% lidocaine without epinephrine.

Ibuprofen (Motrin, Advil, Ibu, Caldolor, Midol)

 

Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)

 

Naproxen is used for relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis.

Indomethacin (Indocin)

 

Indomethacin is rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation. It inhibits prostaglandin synthesis.

Ketoprofen

 

Ketoprofen is used for relief of mild-to-moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses greater than 75 mg do not yield increased therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

Celecoxib (Celebrex)

 

Celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest effective dose of celecoxib for each patient.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli.

Triamcinolone (Kenalog, Aristospan Intra-articular)

 

Triamcinolone decreases inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reversing capillary permeability.

Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol)

 

Methylprednisolone decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.

Betamethasone (Celestone, Celestone Soluspan)

 

Betamethasone decreases inflammation by suppressing migration of PMNs and reversing increased capillary permeability.

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Contributor Information and Disclosures
Author

P Mark Glencross, MD, MPH, FACOEM, FAAPMR Physician in Occupational and Environmental Medicine, Physical Medicine and Rehabilitation, and Sports Medicine, Medical Director of Employee Health, The Methodist Hospital; Medical Director of Occupational Medicine, College Station Medical Center

P Mark Glencross, MD, MPH, FACOEM, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Florida Society of Physical Medicine and Rehabilitation, American College of Occupational and Environmental Medicine, Air Medical Physician Association, Florida Association of Occupational and Environmental Medicine, American Association of Neuromuscular and Electrodiagnostic Medicine, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert F LaPrade, MD, PhD Complex Knee and Sports Medicine Surgeon, The Steadman Clinic; Chief Medical Research Officer, Steadman Philippon Research Institute; Co-Director, Sports Medicine Fellowship Program, Director, International Scholar Program, Adjunct Professor, Department of Orthopedic Surgery, University of Minnesota Medical School; Affiliate Faculty, College of Veterinary Medicine and Biomedical Sciences, Colorado State University

Robert F LaPrade, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Michael T Andary, MD, MS Professor, Residency Program Director, 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

Scott D Flinn, MD Officer in Charge, Surface Warfare Medicine Institute

Scott D Flinn, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

James P Little, MD, MBA, FAAPMR Medical Director, Siskin Hospital for Physical Rehabilitation; Chairman, Associate Professor, Department of Physical Medicine, Southern Rehab Group

Disclosure: Nothing to disclose.

Gerard A Malanga, MD Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

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Location of pes anserinus bursa on medial knee. MCL = medial collateral ligament.
Pes anserinus bursa is located on proximomedial aspect of tibia between superficial medial (tibial) collateral ligament and hamstring tendons (ie, sartorius, gracilis, and semitendinosus). This bursa serves as space where motion occurs between these hamstring tendons and underlying superficial tibial collateral ligament.
 
 
 
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