Pes Anserine Bursitis

• Pes anserine bursitis (tendinitis) involves inflammation of the bursa at the insertion of the pes anserine tendons on the medial proximal tibia.
• The pes anserine or goose's foot is composed of the sartorius, gracilis, and semitendinosus tendons.
• The superficial medial collateral ligament inserts onto the proximal tibia deep to the pes insertion.
• Symptoms include medial pes swelling, pain to touch, warmth, and pain with hamstring activation.
• The cause is usually overuse.
• Treatment involves modification of activities, icing, and stretching.
• Conservative treatment usually resolves this condition.

Patient history with signs and symptoms

• Acute trauma to the medial knee, athletic overuse, chronic mechanical (pes planus) process or degenerative process.
• Pain, tenderness, and localized swelling over the medial knee.
• Worse on ascending and possibly, descending stairs and when rising from a seated position; typically deny pain with walking on level surfaces.
• May have chronic, refractory pain in setting of arthritis or obesity.
• More common in sports requiring side-to-side movements and cutting.
• May have coexistent medial collateral ligament pathology (tenderness superior and posterior to the pes bursa).
• Bilateral symptoms in one third of patients.

Physical Examination

a) Observation

• Localised swelling

b) Palpation

c)Range of motion

• May have pain with resisted internal rotation, resisted flexion, and valgus stress (especially in athletes).

Diagnosis

• Plain radio-graphs- indicated in all patients thought to have pes anserine bursitis.
• Additional tests- complete blood cell count, erythrocyte sedimentation rate, and antinuclear antibody testing maybe indicated.
• MRI of knee- indicated to quantify the extent of internal derangement of the knee and rule out occult mass or tumor.
• Bone scan- maybe used to identify occult stress fractures involving the joint.

Differential Diagnosis

• Degenerative arthritis of knee
• Lumbar radiculopathy
• Bursitis of other bursae of knee
• Entrapment neuropathies of lower extremity, such as femoral neuropathy
• Primary and metastatic tumors of the femur and spine

Treatment

• Initial treatment for pes anserine bursitis starts with activity modification, rest, topical ice (Apply ice packs to the area for 15 to 20 minutes every 2 hours) and non-steroidal anti-inflammatory drugs (NSAIDS) or (COX-2) inhibitors.
• Activity modification consists of modification of inciting activity, for example- reducing the duration, frequency, and intensity of running in a marathoner.
• In overweight subjects it is very important lose weight.
• The use of pillow between the thighs at night times is strongly recommended.
• Biomechanical assessment of the lower limb and analysis of the athlete’s training regime are called for where there is no history of injury.
• Ultrasound therapy has been documented to reduce the inflammatory process.

Exercises for pes anserine bursitis

• Stretching of Quadriceps
• Stretching of sartorius, gracilis, and semitendinosus tendons is strongly recommended.
• Calf Stretch
• Butterfly stretch- seated adductor stretch. Passive and active stretching can promote an important reduction in the tension on the anserine bursa.
• Heel Slides
• Isometric Hamstrings
• Isometric Quadriceps
• Straight Leg Raises
• Dynamic Quadriceps
• Hamstring Curls
• No-Impact Aerobics

During the rehabilitation program, after 2-3 week

• Add squats and lunges
• 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
• Progression of these exercises may involve closed-kinetic chain exercises such as single-knee dips, squats and leg presses. Resisted leg-pulls using elastic tubing are also included.

Pes anserine bursitis recovery time

A regular program of physical therapy usually results in alleviation of the pain and discomfort from pes anserine bursitis anywhere between 2-8 weeks, depending on extent of the damage.

For patients who do not respond to these treatment, injection of the coronary pes anserine bursa with a local anaesthetic and steroid may be a reasonable next step. Surgical excision, bursectomy, is reserved for refractory cases and is rarely needed.

Recent Articles Physical Therapy Abbreviations Jan 05, 20 06:55 PM Common Physical Therapy Abbreviations used in documentation Pes Anserine Bursitis May 26, 17 11:36 AM Pes anserine bursitis (tendinitis) involves inflammation of the bursa at the insertion of the pes anserine tendons on the medial proximal tibia. williams flexion exercises May 22, 17 12:02 PM Williams flexion exercises focus on placing the lumbar spine in a flexed position to reduce excessive lumbar lordotic stresses.

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