Running shoes and inserts should be appropriate for each individual’s biomechanical characteristics. Running gait and cycling mechanics need to be analyzed they should be modified if necessary. Impaired subtalar motion and abnormal tibial rotation should also be addressed. The rehabilitation program focuses on overcoming the biomechanical deficits of the pes anserine muscles, the entire kinetic chain, and the core muscles, as well as correcting any muscle imbalances. Common biomechanical deficits include a weak core musculature, medial hamstrings, and hip adductors. The patient typically complains of pain, with a history of a sudden increase in activity level. Inflammation of the bursa that lies just under the tendons is termed pes anserine bursitis. Pes anserine tendonitis involves acute inflammation and tendinosis (from subacute or chronic irritation) of the tendons of the semitendinosus, sartorius, or gracilis muscles near their insertion at the proximal, anteromedial tibia. The patient should enter a rehabilitation program emphasizing flexibility, and the athlete at risk for repetitive trauma may benefit from padded knee protection.Įlena Milkova Ilieva, in Braddom's Rehabilitation Care: A Clinical Handbook, 2018 Combined Muscle Group Injuries 11-5) 5 to deliver a 1- to 3-mL combination of anesthetic and corticosteroid. After sterile preparation, the knee is fully extended and a 1.0- to 1.5-inch, 22-gauge needle is directed at the point of maximal tenderness ( Fig. The injection is straightforward and effective in reducing inflammatory symptoms.
The palpatory examination will localize the pain to the anserine bursa. Moving the patient’s knee in flexion and extension while internally rotating the leg will reproduce the symptoms.
4,13 Patients report pain inferior to the anteromedial surface of the knee with ascension of stairs. The bursa may also become inflamed as the result of direct trauma in athletes, especially soccer players. Anserine bursitis is commonly seen in women with heavy thighs and osteoarthritis of the knees. It is one of the most commonly inflamed bursae in the lower extremity. The anserine bursa separates the three conjoined tendons of the pes anserinus, or goose’s foot (semitendinosus, sartorius, and gracilis muscles), from the medial collateral ligament and the tibia. Young MD, in Pain Procedures in Clinical Practice (Third Edition), 2011 Anserine Bursitis The medial collateral ligament is crossed at its lower part by the tendons of the sartorius, gracilis, and semitendinosus muscles. This broad, flat, bandlike ligament runs from the medial condyle of the femur to the medial aspect of the shaft of the tibia, where it attaches just above the groove of the semimembranosus muscle it also attaches to the edge of the medial semilunar cartilage. With trauma to the medial knee, the medial collateral ligament is often involved, along with the pes anserine bursa. Rarely, the pes anserine bursa becomes infected. If inflammation of the pes anserine bursa becomes chronic, calcification may occur. The pes anserine bursa is susceptible to the development of inflammation from overuse, misuse, or direct trauma.
This bursa may exist as a single bursal sac or, in some patients, as a multisegmented series of loculated sacs. The pes anserine bursa lies beneath the pes anserine tendon, which is the insertional tendon of the sartorius, gracilis, and semitendinous muscles on the medial side of the tibia ( Fig. Waldman MD, JD, in Atlas of Common Pain Syndromes (Fourth Edition), 2019 The Clinical Syndrome