eMedicine Specialties > Sports Medicine > Knee

Pes Anserine Bursitis: Differential Diagnoses & Workup

Author: Robert F LaPrade, MD, PhD, Professor, Department of Orthopedic Surgery, Divisions of Sports Medicine and Shoulder Services, University of Minnesota Medical School; Director, Orthopedic Biomechanics Lab
Coauthor(s): Scott D Flinn, MD, Force Surgeon, Commander Naval Surface Forces
Contributor Information and Disclosures

Updated: Aug 7, 2009

Differential Diagnoses

Jumper's Knee
Knee Osteochondritis Dissecans
Medial Synovial Plica Irritation
Osgood-Schlatter Disease
Patellofemoral Joint Syndromes

Other Problems to Be Considered

Medial meniscal tear
Plica syndrome
Proximal tibia stress/fracture

Workup

Laboratory Studies

  • Infections of the pes anserine bursa are very rare and occur primarily in immunocompromised patients. These patients have a localized area of warmth, pain, and swelling; a standard laboratory workup for infection is indicated, such as an erythrocyte sedimentation rate (ESR) measurement, complete blood cell count with differential ("CBC with diff"), and C-reactive protein (CRP) level.

Imaging Studies

  • Plain radiographs (standing anteroposterior [AP] and lateral views) are useful to rule out a proximal tibial stress fracture, as well as to help diagnose concurrent pathology, such as medial compartment arthritis or osteochondritis dissecans, which could contribute to tight hamstrings and pes anserine bursal irritation. (See also the eMedicine articles Knee Osteochondritis Dissecans, as well as Medial Compartment Arthritis and Osteochondritis Dissecans [in the Orthopedic Surgery section].)
  • A magnetic resonance imaging (MRI) study may be useful to help diagnose concurrent pathology of the medial compartment.2 The appearance of pes anserine bursitis on MRI is characterized by increased signal intensity and fluid formation around the area of the pes anserine bursa. MRI is also helpful to rule out a proximal tibial stress fracture.3

Procedures

  • A diagnostic or therapeutic lidocaine or lidocaine/corticosteroid injection into the area of the pes anserine bursa may help the clinician to determine the contribution of this pathology to a patient's overall knee pathology, as well as to possibly cut down on the patient's symptoms.

More on Pes Anserine Bursitis

Overview: Pes Anserine Bursitis
Differential Diagnoses & Workup: Pes Anserine Bursitis
Treatment & Medication: Pes Anserine Bursitis
Follow-up: Pes Anserine Bursitis
Multimedia: Pes Anserine Bursitis
References
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References

  1. Mochizuki T, Akita K, Muneta T, Sato T. Pes anserinus: layered supportive structure on the medial side of the knee. Clin Anat. Jan 2004;17(1):50-4. [Medline].

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

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

  4. Butcher JD, Salzman KL, Lillegard WA. Lower extremity bursitis. Am Fam Physician. May 15 1996;53(7):2317-24. [Medline].

  5. 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].

  6. Cox JS, Blanda JB. Peripatellar pathologies. In: Delee JC, Drez D, Stanitski CL, eds. Orthopaedic Sports Medicine: Principles and Practice. Vol 3. Philadelphia, Pa: WB Saunders Co; 1994:1249-60.

  7. Hemler DE, Ward WK, Karstetter KW, Bryant PM. 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].

  8. Kelly SS, Erpelding JM, Kobs J. Knee and lower leg. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:306-65.

  9. Marquis AM. Pes anserine bursitis. ONA J. Oct 1979;6(10):418-9. [Medline].

  10. Medical Economics. Physician's Desk Reference. 54th ed. Montvale, NJ: Thomson Healthcare; 2000.

  11. Mercier LR, Pettid FJ, Tamisiea DF, eds. The knee. Practical Orthopedics. 4th ed. St. Louis, Mo: Mosby-Year Book; 1995:226-7.

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

  13. Seibel MO. Neuromuscular examination. In: Valmassy RL, ed. Clinical Biomechanics of the Lower Extremities. St. Louis, Mo: Mosby-Year Book; 1996:208-20.

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

  15. Yoon HS, Kim SE, Suh YR, Seo YI, Kim HA. 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]. [Full Text].

  16. Zaffagnini S, Golanò P, Farinas O, et al. Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat. Jan 2003;16(1):19-24. [Medline].

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

  18. Wood LR, Peat G, Thomas E, Duncan R. 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].

  19. Nokes SR, Smith T. Acute pes anserine bursitis. J Ark Med Soc. Nov 2007;104(5):112. [Medline].

  20. Clapp A, Trecek J, Joyce M, Sundaram M. Radiologic case study. Pes anserine bursitis. Orthopedics. Apr 2008;31(4):306, 407-8. [Medline].

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Further Reading

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Keywords

pes anserine bursitis, pes anserine tendonitis, pes anserine tendinitis, knee bursitis, pes anserinus tendinobursitis, pes anserine tendino-bursitis syndrome, PATB syndrome

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Contributor Information and Disclosures

Author

Robert F LaPrade, MD, PhD, Professor, Department of Orthopedic Surgery, Divisions of Sports Medicine and Shoulder Services, University of Minnesota Medical School; Director, Orthopedic Biomechanics Lab
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, Force Surgeon, Commander Naval Surface Forces
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.

Medical Editor

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, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Cephalon Honoraria Speaking and teaching

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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