Pes Anserine Bursitis: Cause, Symptoms, Treatment, Exercise

 

Pes Anserine Bursitis

What is a Pes Anserine Bursitis?

Pes anserine bursitis is a condition in which the bursa located at the inner aspect of the knee joint becomes inflamed. The pes anserine bursa is a small, fluid-filled sac that provides cushioning and reduces friction between the tendons of the hamstring muscles and the tibia bone of the lower leg.

This condition typically causes pain, tenderness, and swelling on the inside of the knee, just below the joint line. It is commonly seen in middle-aged women and people who are overweight or have osteoarthritis of the knee.

The most common causes of pes anserine bursitis include overuse or repetitive strain on the knee joint, injury, and degenerative changes in the joint due to aging or arthritis. Treatment options for pes anserine bursitis may include rest, ice, compression, elevation, physical therapy, anti-inflammatory medications, and in some cases, steroid injections or surgery.

Related Anatomy

The pes anserine bursa is located at the medial aspect of the knee, just below the joint line. It is situated between the tendons of three muscles:

• Sartorius: a long, thin muscle that runs from the hip to the medial side of the tibia bone. It helps to flex and rotate the hip and knee joints.
• Gracilis: a long, thin muscle that runs from the pubic bone to the tibia bone on the medial side of the knee joint. It helps to adduct and rotate the hip and flex the knee joint.
• Semitendinosus: a long, thin muscle that runs from the ischial tuberosity of the pelvis to the tibia bone on the medial side of the knee joint. It helps to extend the hip and flex and medially rotate the knee joint.

The pes anserine bursa lies between these tendons and the underlying tibia bone. It helps to reduce friction between the tendons and the bone during movement.

Causes of Pes Anserine Bursitis

Pes anserine bursitis can be caused by a variety of factors, including:

• Overuse or repetitive strain: Repeated stress on the knee joint can cause irritation and inflammation of the bursa, leading to pes anserine bursitis. This can occur in athletes who engage in activities that require a lot of running, jumping, or kicking.
• Injury: Trauma to the knee, such as a direct blow or fall, can cause inflammation of the bursa.
• Obesity: People who are overweight or obese are at a higher risk of developing pes anserine bursitis because the excess weight places more stress on the knee joint.
• Osteoarthritis: This is a degenerative joint disease that can cause inflammation and damage to the knee joint, leading to pes anserine bursitis.
• Other medical conditions: Some medical conditions such as gout, rheumatoid arthritis, or diabetes can increase the risk of developing pes anserine bursitis.
• Improper form or training: Poor running or exercise technique, as well as inadequate training or warm-up, can put excessive stress on the knee joint and increase the risk of pes anserine bursitis.

Muscle imbalances: Weakness or imbalances in the hip or thigh muscles can cause abnormal stresses on the knee joint, leading to pes anserine bursitis.

Symptoms of Pes Anserine Bursitis

The most common symptoms of pes anserine bursitis include:

• Pain: The pain is usually felt on the inside of the knee, just below the joint line. The pain may be sharp, dull, or throbbing, and may worsen with activity.
• Swelling: The affected area may appear swollen and tender to the touch.
• Stiffness: The knee may feel stiff or difficult to move, especially in the morning or after prolonged periods of inactivity.
• Weakness: Weakness in the muscles around the knee, especially the quadriceps and hamstrings, may also be present.
• Clicking or popping: Some people may experience clicking or popping sensations in the knee joint.
• Limited range of motion: The range of motion in the knee joint may be limited, and it may be difficult to fully bend or straighten the knee.
• Warmth or redness: In some cases, the skin over the affected area may feel warm or appear red.

It's important to note that these symptoms can also be caused by other knee conditions, so it's important to see a healthcare provider for an accurate diagnosis.

Risk factor

Several factors can increase the risk of developing pes anserine bursitis, including:

• Age: Pes anserine bursitis is more common in middle-aged and older adults.
• Gender: Women are more likely than men to develop pes anserine bursitis.
• Obesity: Being overweight or obese increases the stress on the knee joint, which can lead to pes anserine bursitis.
• Medical conditions: Certain medical conditions, such as osteoarthritis, rheumatoid arthritis, gout, and diabetes, can increase the risk of developing pes anserine bursitis.
• Improper exercise technique: Poor running or exercise technique can put excessive stress on the knee joint, leading to pes anserine bursitis.
• Muscle imbalances: Weakness or imbalances in the hip or thigh muscles can cause abnormal stresses on the knee joint, increasing the risk of pes anserine bursitis.
• Sports and activities: Certain sports and activities that involve repetitive knee movements, such as running, cycling, or dancing, can increase the risk of pes anserine bursitis.
• Previous knee injury: A previous knee injury, such as a ligament tear or fracture, can increase the risk of developing pes anserine bursitis.

Differential Diagnosis

There are several conditions that can cause similar symptoms to pes anserine bursitis, so it's important to have a healthcare provider perform a thorough examination to determine the correct diagnosis. Some possible differential diagnoses for pes anserine bursitis include:

• Knee osteoarthritis: This is a degenerative joint disease that can cause pain, stiffness, and swelling in the knee joint.
• Medial collateral ligament (MCL) injury: An injury to the MCL can cause pain, swelling, and instability in the knee joint.
• Patellofemoral pain syndrome: This is a condition that causes pain in the front of the knee, often worsened by activities such as running or going up and down stairs.
• Meniscal tear: A tear in the meniscus, the cartilage that cushions the knee joint, can cause pain, swelling, and difficulty with movement.
• Osgood-Schlatter disease: This is a condition that typically affects adolescents and causes pain and swelling in the knee, especially during physical activity.
• Rheumatoid arthritis: This is an autoimmune disease that can cause joint pain, swelling, and stiffness throughout the body, including the knee joint.
• Gout of the Knee: This is a type of arthritis that occurs when uric acid crystals build up in the joints, causing pain, swelling, and inflammation.
• Infection: In rare cases, an infection in the knee joint can cause symptoms similar to those of pes anserine bursitis.

Diagnosis

The diagnosis of pes anserine bursitis typically involves a physical exam, medical history, and diagnostic tests. During the physical exam, the healthcare provider may check for tenderness, swelling, and range of motion in the knee joint. They may also assess the strength of the muscles around the knee.

A medical history can help identify any potential risk factors, such as recent knee injury or medical conditions that may increase the risk of developing pes anserine bursitis.

Diagnostic tests may include imaging studies, such as X-rays or magnetic resonance imaging (MRI), to rule out other knee conditions such as osteoarthritis or a meniscal tear. Blood tests may also be ordered to check for signs of infection or underlying medical conditions.

In some cases, the healthcare provider may also perform a bursa aspiration, which involves using a needle to remove fluid from the affected bursa for further examination. This can help confirm the diagnosis of pes anserine bursitis and rule out other conditions that may cause similar symptoms.

Examination test for Pes Anserine Bursitis

During a physical examination, a healthcare provider may perform several tests to help diagnose pes anserine bursitis. Some of these tests include:

• Palpation: The healthcare provider may press on the inside of the knee to check for tenderness and swelling in the pes anserine bursa.
• Passive knee flexion: The healthcare provider may flex the knee while the patient is lying on their back, which can help identify any pain or discomfort in the pes anserine bursa.
• Active resisted knee flexion: The healthcare provider may ask the patient to flex their knee against resistance, which can help identify any weakness in the muscles around the knee joint.
• Ober's test: This test is used to assess the tightness of the iliotibial band, which can contribute to pes anserine bursitis. The patient lies on their side with their lower leg extended and their upper leg flexed at the hip and knee. The healthcare provider then lifts the upper leg and allows it to drop back down while keeping the hip extended. If the leg stays abducted (i.e., away from the midline of the body), it may indicate tightness in the iliotibial band.

Treatment of Pes Anserine Bursitis

Treatment for pes anserine bursitis typically involves a combination of self-care measures, physical therapy, and medication. In rare cases, surgery may be required.

• Self-care measures: Resting the knee, applying ice packs to the affected area, and using over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help relieve pain and reduce inflammation.
• Physical therapy: Strengthening and stretching exercises can help improve the strength and flexibility of the muscles around the knee joint, which can help reduce stress on the bursa. The physical therapist may also use modalities such as ultrasound, heat or ice therapy to help reduce pain and swelling.
• Medication: If self-care measures and physical therapy are not enough, the healthcare provider may prescribe stronger pain medications or corticosteroid injections to help reduce inflammation and relieve pain.
• Surgery: In rare cases, surgery may be required to remove the affected bursa.
• Preventative measures such as proper warm-up and cool-down exercises before and after physical activity, maintaining a healthy weight, and using proper technique during exercise can help prevent pes anserine bursitis from developing or recurring.

Physiotherapy treatment

Physiotherapy can be an effective treatment for pes anserine bursitis. A physical therapist can design a specific treatment plan based on the individual's symptoms, medical history, and physical examination.

• Range of motion exercises: These exercises help improve the flexibility of the knee joint and surrounding muscles.
• Strengthening exercises: Strengthening the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes, can help reduce stress on the bursa and improve knee stability.
• Manual therapy: Manual therapy techniques, such as massage or joint mobilization, can help improve joint mobility and reduce pain.
• Modalities: Physical therapists can use modalities such as heat or ice therapy, ultrasound, and electrical stimulation to reduce pain and inflammation.
• Gait training: Analyzing and correcting an individual's gait pattern can help reduce stress on the knee joint, which can reduce the risk of bursitis.
• Education: Education on proper exercise techniques, posture, and footwear can help prevent bursitis from recurring.

It's important to work with a qualified physical therapist who can design a customized treatment plan based on the individual's specific needs and goals.

Exercises

Here are some examples of exercises that may be recommended by a physical therapist for pes anserine bursitis:

• Quad sets: Sit on the floor with your legs straight out in front of you. Tighten the muscles at the front of your thigh, and press the back of your knee into the floor. Hold for 5 seconds, and then relax. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Hamstring stretches: Lie on your back with one leg extended straight out in front of you and the other bent with your foot flat on the ground. Hold the back of your thigh with both hands and gently pull your leg towards your chest until you feel a stretch in the back of your thigh. Hold for 30 seconds, and then repeat on the other leg. Repeat for 3-5 repetitions on each leg.
• Clamshells: Lie on your side with your legs bent at a 90-degree angle. Keeping your feet together, lift your top knee as high as you can without moving your pelvis. Hold for 2 seconds, and then lower your leg back down. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Straight leg raises: Lie on your back with one leg bent and the other straight out in front of you. Tighten the muscles at the front of your thigh, and lift your leg up off the ground until it is parallel with your bent knee. Hold for 2 seconds, and then lower your leg back down. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Wall squats: Stand with your back against a wall and your feet shoulder-width apart. Slide down the wall until your knees are bent at a 90-degree angle. Hold for 10-30 seconds, and then slide back up. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.

It's important to only perform these exercises under the guidance of a qualified physical therapist to ensure proper technique and to avoid exacerbating symptoms.

How to Prevent Pes Anserine Bursitis?

Here are some tips to help prevent pes anserine bursitis:

• Warm-up and cool-down: Always properly warm-up before exercising, and cool-down afterwards. This helps prepare the muscles for activity and reduces the risk of injury.
• Strengthen and stretch: Strengthen the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes, and stretch these muscles regularly to improve flexibility and reduce the risk of injury.
• Wear proper footwear: Choose appropriate shoes for your physical activities, such as running shoes for running or cross-training shoes for weight lifting.
• Maintain a healthy weight: Excess weight can put additional stress on the knees and increase the risk of injury.
• Use proper technique: Make sure to use proper technique during exercises to avoid putting unnecessary stress on the knees.
• Gradually increase activity level: Gradually increase the intensity, duration, and frequency of physical activity to avoid overuse injuries.
• Avoid repetitive activities: Try to vary your physical activities to avoid repetitive stress on the knee joint.

By following these tips, you can help reduce your risk of developing pes anserine bursitis and other knee injuries.

Pes Anserine Bursitis recovery time

The recovery time for pes anserine bursitis can vary depending on the severity of the injury and the individual's response to treatment. In mild cases, recovery may only take a few weeks, while more severe cases may take several months to fully heal.

It's important to allow enough time for the bursa to heal completely before returning to physical activity. Continuing to exercise or play sports too soon can prolong the healing process and increase the risk of reinjury.

Working with a qualified healthcare provider, such as a physical therapist or orthopedic specialist, can help ensure an appropriate treatment plan is developed and followed for optimal recovery. Adhering to the treatment plan, including rest, physical therapy, and other recommended interventions, can help speed up recovery time and reduce the risk of recurrence.

Summary

Pes anserine bursitis is a condition characterized by inflammation of the bursa located between the tendons of the hamstring muscles and the shinbone. It typically causes pain and swelling on the inside of the knee and can be caused by overuse, injury, or underlying medical conditions.

Risk factors for pes anserine bursitis include obesity, previous knee injuries, and conditions such as osteoarthritis or diabetes. Diagnosis typically involves a physical exam, imaging tests, and ruling out other potential causes of knee pain.

Treatment for pes anserine bursitis includes rest, ice, compression, and elevation (RICE), medications, physical therapy, and in some cases, corticosteroid injections or surgery. Physical therapy can help improve strength and flexibility in the muscles surrounding the knee joint, and specific exercises such as quad sets, hamstring stretches, clamshells, straight leg raises, and wall squats may be recommended.

Preventive measures include warming up and cooling down before and after exercise, wearing appropriate footwear, maintaining a healthy weight, using proper technique, and gradually increasing activity levels. Recovery time can vary depending on the severity of the injury and the individual's response to treatment, but it's important to allow enough time for the bursa to heal completely before returning to physical activity.