Pes Anserinus Bursitis / Tendinitis

Last week a 35 year old  person comes with severe pain on the medial side of the knee. He is unable to walk properly. Weight bearing and hanging freely increases his symptoms. He is referred from medical college, Thrissur.

He is a  policeman.Pain starts one week back after a intense period of police camp training. Training

 includes vertical jumps, sudden twisting, hill climbing, running etc..

He consulted with orthopaedician and sports medicine specialist

 and they diagnosed as PES ANSERINUS TENDINITIS and referred him for physiotherapy.

There is marked tenderness over the medial side of the knee.

What is PES ANSERNUS TENDINITIS:

Pes anserinus is the anatomic term used to identify the insertion of the conjoined tendons into the anteromedial proximal tibia. From anterior to posterior, the pes anserinus is made up of the tendons of the sartorius, gracilis, and semitendinosus muscles. The tendon's name, which literally means "goose's foo

t," was inspired by the pes anserinus's webbed, footlike structure. The conjoined tendon lies superficial to the tibial insertion of the medial collateral ligament (MCL) of the knee.

Pes anserine bursitis/tendonitis is a painful, inflammatory condition affecting the tendons and/or lubricating sac (bursae) between your shinbone and the hamstring tendons at the inside of your knee; typically caused by stress to the area. Specifically, the pes anserinus is the area where the tendons of 3 muscles (sartorius, gracilis, and semitendinosus) come together. The three tendons merge together in the skin of the bone on the inside surface of the shinbone. The term, pes anserinus means "goose´s foot" in Latin - owing to the webbed-foot pattern the three tendons make when they meet.

The sartorius, gracilis, and semitendinosus muscles are primary flexors of the knee. These 3 muscles also influence internal rotation of the tibia and protect the knee against rotary and valgus stress. Theoretically, bursitis results from stress to this area (eg, stress may result when an obese individual with anatomic deformity fromarthritis ascends or descends stairs). Pathologic studies do not indicate whether symptoms are attributable predominantly to true bursitis, to tendinitis, or to fasciitis, at this site.

Inflammation of the bursae

 or tendons serving these muscles usually develops due to overuse, trauma, or degradation typically from:

• Tight hamstrings
• Obesity
• Poor sport technique, including improper warm-up, excessive hill work, increased mileage
• Biomechanical issues, such as foot rolling, out-turned knees
• Osteoarthritis
• A medial meniscus tear

Causes

Pes anserine bursitis and tendonitis is common in athletes (particularly runners), overweight individuals, an

d often, people with osteoarthritis of the knee. The symptoms of pes anserine bursitis include:

• pain located 2 to 3 inches below the kneecap 
• swelling in front of the kneecap (prepatellar) or underneath the kneecap (infrapatellar)
• Pain increasing with exercise or climbing stairs
• Pain and often warmth and tenderness when touched
• Pain when bending or straightening the knee.
• Pain that radiates to the back and inside of the thigh
• Visible swelling and/or redness of the tendon sheaths (tendonitis)

It is generally agreed that hamstring tightness is the most common cause of pes anserine bursitis/tendonitis. Athletes and non-athletes alike need to ensure their hamstrings are properly warmed-up and stretched before they place any stress on their knee; from extensive hill running to simply climbing stairs. If you are susceptible to PATB or are suffering from it now, you need to take steps to prevent re-injury or ensure recovery.

Treatment:

Physiotherapy and NSAID are the best options for treating Pes Anserinus.

URICE 

U- Ultrasound Therapy

R- Rest

I- Ice

C- Compression

E- Elevation 

Ultrasound is an excellent tool for reduction of swelling and pain when treating the injury. If treatment does not require surgery, rest the area, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day up to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of ultrasound applications over the affected area, as it reduces swelling quickly and increases blood flow to the area, helping the tendon heal more quickly.