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KNEE PAIN

Pes Anserine Bursitis

 

Not all pain around the knee originates within the knee itself. Pain toward the front and the inside of your knee, approximately 2 to 3 inches below the joint, is often a sign of pes anserine bursitis. This may occur with arising from a seated position, at night, or with ascending (or, possibly, descending) stairs, though not usually a problem when walking on level surfaces. A history of sports activity may be associated with susceptible persons involved in sports that requires side-to-side or cutting movements; risk of pes anserine bursitis is higher among runners and in basketball, soccer, and racket sport players.

Anatomy
The pes anserine bursa is a small lubricating sac located between the bony tibia and three tendons of the hamstrings muscle at the inside of the knee – Sartorius, Gracilis, and Semitendinosis – that attach there.

Cause
Bursitis, an inflammation of a bursa, usually develops as the result of overuse or constant friction and stress on the bursa. Pes anserine bursitis is common in athletes, particularly runners. People with osteoarthritis of the knee are also susceptible.
Several factors can contribute to the development of pes anserine bursitis, including:
• Incorrect training techniques, such as neglecting to stretch, doing excessive hill running, and sudden increases in mileage
• Tight hamstring muscles
• Obesity
• An out-turning of the knee or lower leg
• Osteoarthritis in the knee
• Medial meniscus tear
Symptoms
The symptoms of pes anserine bursitis include:
• Gradually increasing pain on the inside of your knee or in the center of the proximal tibia, approximately 2 to 3 inches below the knee joint.
• Pain increasing with forceful knee exertion such as standing from sitting, or climbing stairs
Doctor Examination
Your doctor will examine your knee and talk to you about your symptoms, associated provocative factors, history of activity or injury. An x-ray is usually required for diagnosis, particularly to evaluate arthritis, joint derangement, or fracture.
Treatment
Athletes with pes anserine bursitis should try to optimize their workouts to avoid repetitive injury or irritation of the bursa. Further treatment should include:
Rest. Discontinue the activity or substitute a different activity until the bursitis clears up.
Ice. Apply ice at regular intervals three or four times a day for 20 minutes at a time.
Anti-inflammatory medication. Nonsteroidal anti-inflammatory medication(such as ibuprofen and naproxen), can ease the pain and reduce the inflammation.
Physical Therapy. Modalities, hamstring stretches, and quadriceps strengthening.
Injection. If symptoms are persistent, an injection of local anesthetic and steroid into the bursa, usually provides prompt relief.