Pes Anserine Bursitis

THE CLINICAL SYNDROME

The pes anserine bursa lies beneath the pes anserine tendon of the sartorius, gracilis, and semitendinous muscles to the medial side of the tibia. This bursa may exist as single bursal sacs or, in some patients, as a multisegmented series of sacs that may be loculated in nature. Patients with pes anserine bursitis will present with pain over the medial knee joint and increased pain on passive valgus and external rotation of the knee. Activity, especially involving flexion and external rotation of the knee, will make the pain worse, with rest and heat providing some relief. Often, the patient will be unable to kneel or to walk down stairs.

Patients with pes anserine bursitis will frequently complain of medial knee pain that is made worse with kneeling or walking down stairs.

SIGNS AND SYMPTOMS

The pain of pes anserine bursitis is constant and characterized as aching in nature. The pain may interfere with sleep. Coexistent bursitis, tendinitis, arthritis, and/ or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint. Frequently, the medial collateral ligament is also involved if the patient has sustained trauma to the medial knee joint. If the inflammation of the pes anserine bursae becomes chronic, calcification of the bursae may occur.

Physical examination may reveal point tenderness in the anterior knee just below the medial knee joint at the tendinous insertion of the pes anserine. Swelling and fluid accumulation surrounding the bursa is often present. Active resisted flexion of the knee will reproduce the pain. Sudden release of resistance during this maneuver will markedly increase the pain. Rarely, the pes anserine bursa will become infected in a manner analogous to infection of the prepatellar bursa.

TREATMENT

A short course of conservative therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs, or cycloocygenase-2 inhibitors and a knee brace to prevent further trauma is a reasonable first step in the treatment of patients suffering from pes anserine bursitis. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step.

To inject the pes anserine bursa, the patient is placed in the supine position with a rolled blanket underneath the knee to gently flex the joint. Coexistent bursitis, tendinitis, arthritis, and internal derangement of the knee may also contribute to the patient’s pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The described injection technique is extremely effective in the treatment of pain secondary to pes anserine bursitis. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for pes anserine bursitis pain. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique. The major complication of this injection technique is infection. This complication should be exceedingly rare if strict aseptic technique is followed. Approximately 25% of patients will complain of a transient increase in pain after injection of the pes anserine bursa of the knee and should be warned of such.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.