Pes Anserinus Syndrome

Description

The pes anserinus is the tendon insertion of three muscles of the thigh into the upper part of one of the lower leg bones, the tibia, just below the knee, to the inner side of the front of the leg. Where the tendon attaches to bone, there is a bursa, a fluid-filled cushion, between the bone and the tendon. The bursa is like a water balloon, and its function is to reduce friction and wear of the tendon where it rubs against the bone. With pes anserinus syndrome, inflammation and pain occur in the bursa (bursitis), tendon (tendinitis), or both.

Common signs and symptoms

• Pain, tenderness, swelling, warmth, or redness over the pes anserinus bursa and tendon on the front, inner part of the leg 2 to 3 inches below the knee

• Pain that is usually slight when beginning to exercise that worsens as the activity continues

• Pain with running or bending the knee against resistance

• Crepitation (a crackling sound) when the tendon or bursa is moved or touched

Causes

• Strain from a sudden increase in amount or intensity of activity or overuse of the lower extremity, usually in endurance athletes or in new runners

• Direct trauma to the upper leg

Factors that increase risk

• Endurance sports (distance runs, triathlons)

• Beginning a training program

• Sports that require pivoting, cutting (sudden changes of direction while running), jumping, and deceleration

• Incorrect training techniques, including excessive hill running, recent and substantial increases in mileage, and inadequate time for rest between workouts

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Knocked knees

• Arthritis of the knee

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness, knee and thigh flexibility (especially the hamstrings), and muscle strength and endurance.

• Use proper training technique, including reducing mileage and shortening stride length.

• Arch supports (orthotics) may be helpful for people with flat feet.

Expected outcome

Pes anserinus syndrome is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.

Possible complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• A chronically inflamed tendon and bursa, causing persistent pain with activity that may progress to constant pain

• Recurrence of symptoms if activity is resumed too soon, with overuse, with a direct blow, or when using poor technique

General treatment considerations

Initial treatment consists of medication and ice to relieve pain; stretching and strengthening exercises, particularly for the hamstring muscles; and modification of the activity that initially caused the problem. These exercises can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Arch supports (orthotics) for people with flat feet may be prescribed to reduce stress to the tendon. A knee sleeve or bandage may help keep the tendon and bursa warm during activity and may reduce some of the symptoms. An injection of cortisone into the bursa may be recommended, but surgery to remove the inflamed bursa is usually only considered after at least 6 months of conservative treatment, or when the condition recurs many times, and the bursa is very large.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers are usually not prescribed for this condition. If your physician does prescribe pain medications, use them only as directed.

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