Can anserine bursitis be easily treated?

Can Anserine Bursitis Be Easily Fixed?

Yes, anserine bursitis can be effectively treated with conservative management in most cases, typically resolving within 4-6 weeks using rest, ice, NSAIDs, and activity modification. 1

Initial Conservative Management (First-Line Treatment)

The American College of Physicians recommends starting with conservative therapy for acute bursitis, which includes: 1

• Rest and activity modification for 4-6 weeks to eliminate pressure or repetitive motion on the affected bursa 1
• Ice application for 10-minute periods through a wet towel for pain relief 1
• NSAIDs as first-line pharmacologic therapy to control pain and inflammation 1
  • Naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours for acute bursitis 2
  • Initial total daily dose should not exceed 1250 mg of naproxen, with subsequent daily doses not exceeding 1000 mg 2

Clinical outcomes show good response rates: Conservative treatment with NSAIDs typically reduces pain significantly, with studies showing pain relief beginning within 1 hour of naproxen administration and lasting up to 12 hours. 2, 3

When Conservative Treatment Fails (After 4-6 Weeks)

If symptoms persist beyond 4-6 weeks of appropriate conservative management, consider escalation: 1

• Ultrasound-guided corticosteroid injection into the pes anserine bursa 1, 4

  • Corticosteroid injections show statistically significant improvement in pain scores at 1 week post-injection 5
  • However, effects may be shorter-lasting compared to alternative injection therapies 5

• Alternative injection options (if corticosteroids are contraindicated or ineffective):

  • Oxygen-ozone injection shows sustained benefit at both 1 week and 8 weeks 5
  • Prolotherapy (dextrose 20%) demonstrates longer-lasting effects, particularly at 8-week follow-up 5

Critical Safety Considerations

Never inject corticosteroids into a potentially infected bursa, as this can worsen infection. 1 You must rule out septic bursitis before any corticosteroid treatment by assessing for:

• Fever or systemic signs of infection
• Marked warmth and erythema over the bursa
• Recent trauma with skin break

Avoid routine aspiration of chronic microtraumatic bursitis to prevent iatrogenic septic bursitis. 1

Prevention of Recurrence

Address modifiable risk factors to prevent recurrence: 1

• Eliminate repetitive motion patterns that stress the medial knee
• Weight reduction if obesity is present
• Control metabolic conditions (diabetes, gout)
• Review and potentially adjust diuretic medications
• Reduce excess alcohol intake

When to Refer

Refer to orthopedic surgery for: 1

• Refractory cases not responding to 6-8 weeks of conservative treatment plus injection therapy
• Surgical candidates requiring bursal excision

Refer to rheumatology when: 1

• Systemic inflammatory disease is suspected as the underlying cause
• Multiple joint involvement suggests systemic rheumatic disease

Expected Timeline

Most cases resolve within 4-6 weeks with conservative management alone. 1 However, recovery can range from 10 days to 36 months in complicated cases, particularly when associated with knee osteoarthritis. 6 Studies using mesotherapy with diclofenac show sustained improvement at 90-day follow-up with reduction of the hypoechoic area on ultrasound. 6