II. Epidemiology

  1. Often seen in middle aged, over-weight women

III. Causes

  1. Medial Knee Osteoarthritis (early, common finding)
  2. Direct Trauma
  3. Overuse injury

IV. Symptoms

  1. Medial Knee Pain
  2. Skin numbness below Patella may be present
  3. Provocative: Repetitive flexion and extension

V. Signs

  1. Tenderness over pes anserine bursa (Posteromedial knee)
    1. Distal to medial joint line (below tibial plateau)
    2. Sandwiched between ligament and tendon on medial knee
      1. Medial collateral ligament beneath bursa
      2. Medal thigh tendons pass over bursa and insert
        1. Sartorius Muscle
        2. Gracilis Muscle
        3. Semitendinosus Muscle
  2. Provocative Maneuvers
    1. Prone resisted knee flexion (Hamstring contraction)
    2. Supine valgus stress testing (Tibia rotation)
    3. Direct palpation

VI. Differential Diagnosis

  1. Medial Meniscus Injury
  2. Medial Collateral Ligament Sprain
  3. Knee Osteoarthritis (medial)

VII. Management

  1. NSAIDs
  2. Local Ice Therapy
  3. Modify activities
  4. Pes Anserine Injection

VIII. References

  1. Greene (2001) Musculoskeletal Care, AAOS, p. 335-6
  2. Cardone (2003) Am Fam Physician 67(10):2147-52 [PubMed]

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