Pes Anserine Bursitis Treatment & Management

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

Acute Phase

Rehabilitation Program

Physical Therapy

Patients with pes anserine bursitis need to work on both a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program. This type of program can usually be taught to the patient by an athletic trainer or physical therapist. Patients should understand that, to gain the maximum benefit from this program, they need to stretch their hamstrings frequently during the day, sometimes hourly. The quadriceps strengthening program is recommended in most patients because of other concurrent pathology in the knee.

A regular program of hamstring stretching and quadriceps strengthening usually results in alleviation of the pain from pes anserine bursitis in approximately 6-8 weeks. Addition of a nonsteroidal anti-inflammatory drug (NSAID) may help to alleviate some of the pain at this time, and an ice massage may help to reduce inflammation. Cutting back or eliminating the offending activities is also important.

Recreational Therapy

In patients with generalized anterior knee pain, activity modification may be necessary to allow the joint to quiet down and to allow the hamstring tightness to resolve. In most patients, this modification involves minimizing the use of stairs, climbing, or other activities that cause irritation of the joint.

Surgical Intervention

The need for surgery is very rare in cases of pes anserine bursitis. Surgery is usually indicated in cases in which an immunocompromised patient has a localized infection that does not resolve with standard antibiotic treatment. Surgical decompression of the bursa may be indicated in such cases.

Consultations

Recalcitrant cases that do not respond to a program of activity modification and exercise may need a referral to a specialty-trained, sports medicine physician, primary care physician, or orthopedic surgeon for evaluation.

Other Treatment

Local anesthetic (typically lidocaine) and corticosteroid (Celestone) injection directly into the bursa is another treatment option. This should be considered only for refractory cases that have not responded to physical therapy, rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs). No more than 3 injections should be used over a 1-year period, with at least 1 month between injections; however, patients who do not respond to the initial injection rarely respond to repeat treatments.[2] When injecting the bursa, make certain to avoid injecting any of the 3 tendons converging at the pes anserinus because this can intensify the patient’s pain and weaken the tendons.

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Recovery Phase

Rehabilitation Program

Physical Therapy

During the rehabilitation program, the patient should incorporate the following measures:

  • Continue with activity modification as necessary.
  • Begin a gradual resumption of activities.
  • Continue alternative training for cardiovascular fitness.
  • After regaining full, pain-free motion with good isometric strength, work on improving strength and endurance.

Medical Issues/Complications

Pes anserine bursitis is primarily a self-limiting condition, which responds well to an exercise/stretching program.[9] Recalcitrant cases should be referred to a specialist to confirm the diagnosis and to rule out other causes of the patient's pain (eg, proximal tibial plateau fracture).

Surgical Intervention

See Treatment, Acute Phase, Surgical Intervention.

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Maintenance Phase

Rehabilitation Program

Physical Therapy

Continue to work on a hamstring stretching program and a concurrent closed-chain quadriceps strengthening program.

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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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