Symptoms of Pes Anserine Bursitis
Pes anserine bursitis presents with pain and tenderness over the proximal medial tibia just below the knee, often accompanied by localized swelling, with symptoms typically aggravated by activity and knee flexion. 1
Primary Clinical Features
The hallmark symptoms include:
- Pain localized to the medial knee at the insertion site of the conjoined tendons (sartorius, gracilis, and semitendinosus) on the upper medial tibia 2, 1
- Point tenderness over the medial anterior aspect of the tibia approximately 2-3 inches below the knee joint line 1
- Palpable swelling of the bursa in the affected area 1
- Pain with resisted knee flexion due to involvement of the hamstring tendons 2
Functional Limitations
Patients commonly experience:
- Reduced range of motion of the knee joint 2
- Decreased knee strength particularly with flexion movements 2
- Pain that worsens with activity, especially climbing stairs or rising from a seated position 3
- Difficulty with weight-bearing activities on the affected limb 4
Associated Clinical Context
Important contextual features to recognize:
- Predominantly affects middle-aged to older women, particularly those who are obese 1
- Frequently occurs in patients with underlying degenerative knee arthritis (present in approximately 83% of cases) 1
- May be associated with varus or valgus knee deformities 1
- Can develop following total knee replacement surgery, though this is rare 4
Diagnostic Confirmation
While the diagnosis is primarily clinical based on the symptom pattern described above, ultrasonography can confirm the presence of bursal inflammation and measure the depth of swelling 3, and is particularly useful when the diagnosis is uncertain or when guiding therapeutic injections 2, 4.
A common pitfall is confusing pes anserine bursitis with medial meniscal pathology or medial collateral ligament injury—the key distinguishing feature is that tenderness in pes anserine bursitis is located more distally on the tibia, below the joint line, rather than at the joint line itself 1.