What is the diagnostic approach for Pes anserinus (Pes anserine) bursitis?

From the Guidelines

Diagnosing Pes anserine bursitis involves a combination of clinical evaluation and sometimes imaging studies, with MRI being the most sensitive and specific modality for detecting soft tissue abnormalities, including bursal fluid collection or inflammation, as noted in the American College of Radiology Appropriateness Criteria for chronic hip pain 1. The diagnosis typically begins with a thorough history and physical examination, focusing on medial knee pain that worsens with activities like climbing stairs or getting up from a seated position. During examination, the physician will look for tenderness at the medial aspect of the proximal tibia, about 2-3 cm below the joint line where the sartorius, gracilis, and semitendinosus tendons insert. Some key points to consider in the diagnostic approach include:

• Risk factors such as obesity, valgus knee deformity, and activities involving repetitive knee flexion
• Clinical signs like pain reproduced with resisted knee flexion or internal rotation of the tibia
• The use of imaging studies to rule out other conditions, with X-rays helping to exclude bone abnormalities
• The utility of ultrasound or MRI in confirming bursal fluid collection or inflammation, and MRI's particular usefulness in identifying other potential causes of medial knee pain
• The role of diagnostic and therapeutic injections of local anesthetic and corticosteroid into the bursa in confirming the diagnosis, as discussed in the context of hip pain diagnosis 2. It's also important to note that laboratory tests are generally not necessary unless systemic inflammatory conditions are suspected, and that the diagnosis is often confirmed when symptoms improve after a diagnostic and therapeutic injection of local anesthetic and corticosteroid into the bursa.

From the Research

Diagnostic Approach for Pes Anserinus (Pes Anserine) Bursitis

The diagnostic approach for Pes anserinus (Pes anserine) bursitis involves several methods, including:

• Clinical evaluation: Pes anserine bursitis is characterized by inflammation of the bursa located between the medial aspect of the tibia and the hamstring muscles 3.
• Imaging studies: + Ultrasonography: can be used to diagnose Pes anserine bursitis, as seen in two cases reported in 2015 3. + Magnetic Resonance (MR) imaging: can help make an accurate diagnosis and distinguish among various masses, including bursae, recesses, meniscal and ganglion cysts, and benign and malignant soft tissue masses 4.
• Physical examination: patients with Pes anserinus tendino-bursitis typically present with proximal medial tibial pain and swelling 5.

Diagnostic Considerations

When diagnosing Pes anserine bursitis, it is essential to consider other potential causes of lower extremity pain, including:

• Other types of bursitis, such as ischiogluteal, greater trochanteric, medial collateral, prepatellar, popliteal, and retrocalcaneal bursitis 6.
• Degenerative or inflammatory knee arthritis, which can increase the risk of developing Pes anserine bursitis 3.

Diagnostic Tools

Various diagnostic tools can be used to evaluate patients with Pes anserine bursitis, including:

• Visual analog scale (VAS) for pain evaluation 7, 5.
• Western Ontario and McMaster Universities (WOMAC) pain score and physical function score 7.
• Ritchie articular index (RAI) for tenderness 7.
• Sonography to measure the depth of swelling 5.