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pes anserine bursitis

Epidemiology: 1) more common in overweight women 2) frequently occurs in patients with osteoarthritis 3) frequently occurs in patients with varus deformities Clinical manifestations: 1) history of overuse or change in activity 2) stair-climbing may exacerbate symptoms 3) tenderness localized along insertion of the sartorius, gracilis, & semitendinosus tendons which overlie the anteromedial tibia inferior to the joint line (knee) ~ 5 cm distal to the medial articular line of the knee 4) symptoms exacerbated when knee & hip are flexed to 90 degrees & the femur is internally rotated against resistance 5) negative valgus stress test (intact medial collateral ligament) 6) symptoms worse with activity & at night [2] Radiology: - X-ray of knee & tibia (no bony patholgy) Management: 1) see bursitis 2) eliminate squatting & direct pressure on the anserine bursa 3) avoid crossing legs 4) limit repititious bending 5) apply ice for 15 minutes every 4-7 hours for pain 6) glucocorticoid/local anesthetic injection generally brings prompt relief 7) NSAIDs may not concentrate well in anserine bursa. - NSAIDs, activity modification, & physical therapy treatment of choice [6]

Related

pes anserine bursa pes anserine pain syndrome

General

bursitis repetitive strain disorder; repetitive motion disorder; cumulative trauma disorder; overuse syndrome

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 673-74
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2018.
  3. Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. UpToDate Online version 15.1 http://www.utdol.com
  5. Schraeder TL, Terek RM, Smith CC. Clinical evaluation of the knee. N Engl J Med. 2010 Jul 22;363(4):e5 PMID: 20660399
  6. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. J Clin Rheumatol. 2004 Aug;10(4):205-6. PMID: 17043509
  7. NEJM Knowledge+ Rheumatology