Pes Anserine Bursitis Clinical Presentation

  • Author: Robert F LaPrade, MD, PhD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jul 22, 2011
 

History

The chief complaint of patients with pes anserine bursitis, either as a main component or as part of several causes of knee pain, is pain along the medial aspect of the knee. Although patients sometimes point to an area directly over the pes anserine bursa, they may often point to a rather diffuse region over the medial aspect of the knee. This diffuse pain may occur because many of these patients may also have plical irritation or medial joint compartment pathology (eg, medial meniscal tears, medial compartment arthritis). Pes anserine bursitis should not be overlooked when the diagnosis of osteoarthritis of the knee is made because the 2are commonly associated.[6]

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Physical

On physical examination, the pes anserine bursa can be palpated at a point slightly distal to the tibial tubercle and about 3-4 cm medial to it (about 2 fingerbreadths). Pain in this area indicates an underlying inflammation of the pes anserine bursa or a bursitis. Palpation of this area of the knee is important in a patient who complains of medial-sided knee pain because the examiner needs to ensure that the pain is truly from joint line pathology or from pes anserine bursal pathology (or both).

Concurrent with the physical examination finding, the hamstring-popliteal angle should be assessed to determine the patient's underlying amount of hamstring tightness. This assessment is made by having the patient's hip flex to 90°, and then passively extending the leg. The angle formed between a perpendicular line to the femoral shaft and the tibial shaft is the hamstring-popliteal angle.

At its worst, pes anserine bursal pain is only mild to moderate. Intense pain could suggest a proximal tibial stress fracture.

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Causes

The main cause of pes anserine bursitis is underlying tight hamstrings, which are believed to place extra pressure on the bursa, causing bursal irritation. In addition, some patients may have bursal irritation due to a direct blow and experience a contusion to this area, as well as resultant inflammation. Pes anserine bursitis is a common finding in patients who have concurrent Osgood-Schlatter syndrome, suprapatellar plical irritation, or other causes of joint irritation, which may make the hamstrings spasm (eg, meniscal tears, underlying arthritis). Patients with planovalgus feet and the resultant overpronation with running may also be at risk for irritation of the bursa.

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Contributor Information and Disclosures
Author

Robert F LaPrade, MD, PhD  Complex Knee Surgeon, The Steadman Clinic, Vail, Colorado; Director, Biomechanics Research Department, Steadman Philippon Research Institute, The Steadman Clinic

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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

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.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

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

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The pes anserine bursa is located on the proximomedial aspect of the tibia between the superficial medial (tibial) collateral ligament and the hamstring tendons (ie, sartorius, gracilis, semitendinosus). The pes anserine bursa serves as a space where motion occurs between these hamstring tendons and the underlying superficial tibial collateral ligament.
 
 
 
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