Pes Anserine Bursitis

Pes Anserine Bursitis Definition

Pes Anserine Bursitis (PAB) is a condition of the knee in which the fluid-filled bursa in the conjoined insertion of the three hamstring muscles gets inflamed causing pain. It is not sudden but occurs gradually. It can be a cause of discomfort apart from being responsible for limiting functionalities of an individual.

This condition is also known as pes anserinus or anserine bursitis.

Pes Anserine Bursitis ICD 9 Code

The ICD9 code of this condition is 726.61.

Pes Anserine Bursitis Incidence

Correct data about the occurrence of PAB is not known due to the lack of studies in this regard. However, it is among the notable findings in patients complaining about anterior knee pain. Observation shows that obese women and type 2 diabetic patients are more affected. According to sources, around 60% of diabetic patients had bilateral form of this bursitis. Patients having osteoarthritis also have high occurrences of this bursitis.

Analysis of almost 500 MRI reports of patients who were suspected of derangement of some sorts showed presence of PAB in approximately 2.5% of them. However, it could not be established whether people with greater body mass were more prone to this disease. Athletes who are into rigorous running and cycling are quite prone to it apart from middle aged people.

Pes Anserine Bursitis Location

Pes anserine bursa is located within the knee, between tibia and hamstring muscle tendons namely semimembranosus, semitendinosus and biceps femoris. This bursa supplies lubrication when these tendons, muscles and bones move creating friction. Inflammation in this bursa causes bursitis which can be managed in appropriate ways.

Pes Anserine Bursitis Symptoms

Symptoms which surface with the occurrence of this condition are:

Picture of Pes Anserine Bursitis

Picture 1 – Pes Anserine Bursitis

  • Knee pain accompanied with tenderness and swelling. Pain may worsen while standing up from sitting position or climbing up and down the stairs.
  • Aches inside the knee, a couple of inches below the joint.
  • Chronic refractory pain, sensed in obese women or those with arthritis with increased activities which injure the knee.
  • Difficulty in maintaining balance and waking for long.
  • Limited range of functions – affecting sitting or bending the knee.

Pes Anserine Bursitis Causes

PAB may occur due to varied causes. Irritation in the pes anserine bursa may occur due to physical trauma or overuse of the hamstring muscles. Repeated kicks or actions can harm it equally. The primary cause of this kind of knee bursitis is the extremely tight hamstrings which exert tremendous pressure on it causing inflammation of the bursa.  This is common in patients who are diagnosed with suprapatellar plical irritation, Osgood-Schlatter syndrome or underlying arthritis. Sometimes, a direct hit to that area may result in trauma causing bursitis.

Pes Anserine Bursitis Diagnosis

As PAB may show symptoms which are similar to other knee disorders, it is important that it is carefully diagnosed. Diagnosis includes clinical assessment which depicts the inflammation in the bursa. In patients where an infection is present, some laboratory studies can be conducted.

  • Physical examination helps locate the swelling and pain on inside the knee.
  • MRI scan or magnetic resonance imaging has by far been the highly preferred diagnostic tool for PAB.
  • Ultrasound can be used for diagnosing pes anserine bursitis.
  • CT scans have been similarly useful in locating bursitis in pes anserine.
  • X-rays are primarily not advised to diagnose this condition although lateral pictures may help in distinguishing it from other medical conditions like proximal tibial stress fracture.
  • Tendinitis can be present with it in some cases, depending on the location of the swelling.

Pes Anserine Bursitis Differential Diagnosis

Medial collateral knee ligament injury, Prepatellar Bursitis, Jumper’s Knee, Gout, Pseudo gout, tumors and other knee bursitis are some of the conditions taken for differential diagnosis.

Pes Anserine Bursitis Treatment

An important aspect of healing is restricting any kind of activities which in turn makes the pain worsen the pain. This applies to the athletes who should refrain from strenuous activities to allow rest to the affected knee. Some of these means can be adopted for treatment:

Image of Pes Anserine Bursitis

Picture 2 – Pes Anserine Bursitis Image

Ice pack application

Apply ice pack over the affected area to ease the inflammation. Ice massage can be given with the help of foam cups, directly on the skin. Ice packs can be applied after an interval of 3 to 4 hours for around 30 minutes till pain subsides.

NSAIDs

NSAIDs or non-steroidal anti-inflammatory drugs are administered for providing relief from pain.

Physical therapy

Physical therapy is one of the trusted and effective treatment modalities which help patients get back to their routine. Exercise programs which include hamstring stretches and quadriceps strengthening, are usually advised to them.

Ultrasonography

Besides the options given above, patients may be provided with ultrasonography as an effective means of treating this form of bursitis.

Corticosteroids or local anesthetics

If relief could not be provided with these aforementioned options, injection of corticosteroids or local anesthetics may prove to be beneficial. This requires expert intervention to improve efficacy and avoid risks associated with it.

By draining out the fluid accumulated in the bursa, respite can be provided in severe conditions.

In rare cases, surgery is advised when an infection has occurred that could not be treated with antibiotics. To prevent needless surgeries, it should be aptly diagnosed.

Pes Anserine Bursitis Healing Time

In around 7 to 8 weeks, a PAB-affected person may start feeling better as his symptoms begin to diminish. This may be longer for patients who are also suffering from chronic arthritis. Pain can yet be considerably reduced with the aid of right treatment plan. Healing time does not usually extend beyond a couple of months. However, one should never exaggerate or stress their knee before it has healed completely.

Pes Anserine Bursitis vs Tendonitis

Pes Anserine tendonitis is a condition that occurs with the inflammation in the tendons which form the Goose feet or pas anserine tendon. Unlike tendonitis, PAB is formed in the bursa which acts as a cushion against the tendons or the other structures surrounding it.

Pes Anserine Bursitis Prognosis

Although PAB may subside on its own, it is better resolved on proper treatment. It may not be life threatening, but infections may occur in rare cases of recalcitrant bursitis in which injection is not properly administered. Individuals engaged with sports and other activities may resume their routine once they are cured.

Pes Anserine Bursitis Prevention

To prevent injury or stress to the bursa in the knee, athletes should undertake exercises like hamstring stretches. Warm-up exercises like these will help in preventing injuries. Try and take up exercises gradually and not all at once to avoid excess stress.