What Is Pes Anserine Bursitis?

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Pes anserine bursitis occurs when the pes anserine bursa becomes painful and inflamed. This bursa is found on the inside of the knee joint. It lies between your shin bone and three tendons that connect the hamstring muscles to the shin bone.

When this bursa is harmed due to overuse, damage, or disease, it makes too much fluid. This causes swelling, which puts pressure on other parts of your knee. Pain that worsens with certain movements results.

This article describes pes anserine bursitis symptoms, causes, diagnosis, and treatment.

knee pain

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Types of Bursitis

Pes anserine bursitis is a type of bursitis. Bursitis is a soft tissue condition that causes inflammation of a bursa, a small, flat fluid-filled sac of synovial fluid, the lubricant that cushions the friction between a bone and muscle or skin and tendon. It also acts as a shock absorber to soften the impact on your joints.

Bursitis can be classified based on its location. There are about 160 bursae in your body. Bursitis most often affects the bursae in the knee, shoulder, elbow, hip, buttocks, and calf. The pes anserine bursa is one of 13 bursae that surround your knee.

When a bursa becomes inflamed, it can be categorized as:

  • Septic bursitis: This involves the inflammation of a bursa due to bacteria, though other organisms like fungi or algae can also trigger this reaction.
  • Aseptic bursitis: This accounts for about two-thirds of all bursitis cases. It can also occur after an acute trauma (injury from a single event), an overuse injury, crystal deposition such as gout, or a systemic disease like diabetes.

Pes Anserine Bursitis Symptoms

Pes anserine bursitis symptoms typically involve pain. The pain may be worse in the morning when the joint has remained in a fixed position for a while. The degree of pain you experience depends on the extent of your condition.

Common symptoms of pes anserine bursitis include the following:

  • Pain that gradually develops in an area about 2–3 inches below the knee joint, occurring on the inside of your knee and/or in the center of the shinbone
  • Pain that may extend to the front of the knee and down the lower leg
  • Pain that increases with exercise or climbing up and down stairs
  • Pain that increases when rising from a seated position or sitting with legs crossed
  • Pain that awakens you when sleeping on your side
  • Muscle weakness and decreased range of motion at the knee joint
  • Local swelling or tenderness to the touch in the affected area
  • Improvement of pain with rest

Causes

Pes anserine bursitis occurs when the pes anserine bursa becomes irritated, usually as a result of continued friction and stress. When irritation occurs, the bursa reacts by producing too much fluid. The extra fluid causes inflammation and additional pressure on nearby areas in the knee.

Pes anserine bursitis can affect anyone, though it most often affects athletes who engage in activities that involve running. It is also common in overweight, middle-aged females. Being overweight increases the load that your knee joints have to carry, causing more than a normal amount of stress on the pes anserine bursa.

The following risk factors are associated with the development of pes anserine bursitis:

Diagnosis

Diagnosis of pes anserine bursitis requires an evaluation by a healthcare provider. A complete physical examination to evaluate your symptoms includes:

  • Identifying the location of pain and area of tenderness
  • Assessing for pain on the inside of your knee
  • Testing for knee and hip strength
  • Testing for knee and hip range of motion to evaluate for full extension
  • Examining your knee and hip posture and alignment
  • Observing your gait (way in which you walk) and how you perform other sports-specific tasks
  • Discussing your symptoms
  • Going over your medical history

Your healthcare provider may also use the following imaging tests to confirm the diagnosis and rule out a bone fracture, medial meniscus tear, or other conditions that may be causing your symptoms:

In rare cases, your healthcare provider may want to examine a sample of synovial fluid from the pes anserine bursa. This can be done by using a needle and syringe to extract the fluid for analysis.

Treatment

Treatment for pes anserine bursitis usually begins with conservative measures. The goals of treatment are to reduce physical strain on the pes anserine bursa; decrease inflammation, stiffness, and pain; and provide time for the bursa to recover. If necessary, the treatment also involves therapy for an underlying cause.

The most common treatment of pes anserine bursitis involves the following therapies:

  • Rest: This includes modifying or eliminating the activities that aggravate your condition.
  • Ice: Ice application reduces inflammation and pain. Apply ice to the affected area for 20-minute periods three or four times daily.
  • Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) drugs like Motrin or Advil (ibuprofen), aspirin, and Aleve or Naprosyn (naproxen) can reduce inflammation and pain. Topical NSAIDs, like Solaraze (diclofenac), Myoflex cream (trolamine salicylate), or Zostrix (capsaicin) may also provide relief.
  • Steroid injection: An injection of cortisone and an anesthetic together into the pes anserine bursa can often provide relief, especially when pain is severe or causing sleep disturbances.
  • Physical therapy: Muscle-strengthening exercises involving the quadriceps muscles may help with the long-term improvement of symptoms. This may involve a formal physical therapy program or at-home exercises based on your healthcare provider's recommendation. These exercises typically aim to stretch and increase flexibility in the muscles around your knees, upper legs, and abdomen to help prevent the onset or recurrence of pes anserine bursitis.
  • Weight loss: If you are experiencing overweight or obesity, losing the extra pounds can reduce the stress on the pes anserine bursa and help prevent the recurrence of bursitis in the future. Your healthcare provider may advise that you participate in a managed weight-loss plan to help you achieve a healthy weight.
  • Surgery: Surgical intervention is usually not considered unless conservative treatment has failed over a long period. Procedures that involve bursa incision and drainage may relieve pain and inflammation. If the bursa is severely damaged, removal may be an option. Surgical excision of a bursa, called a bursectomy, can be performed with open surgery or arthroscopic surgery, which uses a scope and keyhole incisions to perform the procedure.

Prognosis

The prognosis of most cases of pes anserine bursitis is a long-term resolution of symptoms after appropriate treatment.

Pes anserine bursitis is considered a self-limiting condition. The length of time it takes to resolve the condition varies. Six to eight weeks of stretching and strengthening for most patients can help reduce symptoms.

Having underlying conditions such as obesity or osteoarthritis can make it more difficult to achieve relief until these problems are treated. Without treatment, pain and inflammation can increase, weakening the muscles and tendons surrounding the knee joint.

What Aggravates Pes Anserine Bursitis?

You can aggravate pes anserine bursitis by ignoring symptoms and trying to work through the pain. Treatment for this overuse condition involves rest and strategies to reduce inflammation so the pes anserine bursa can calm. Without treatment, there is no time for the pain and inflammation to resolve. Continuing to perform repetitive activities—such as certain sports and stair climbing—can aggravate and worsen symptoms.

Coping

Following the treatment program advised by your healthcare provider is the best way to promote relief from pain and inflammation. Controlling underlying conditions—like obesity and diabetes—can also promote healing and prevent pes anserine bursitis recurrence.

If you are at risk of pes anserine bursitis or want to avoid a recurrence of the problem, follow these strategies:

  • Properly warm up before beginning a sport or heavy physical activity.
  • Learn the correct knee positioning to use during your athletic activities.
  • Maintain good physical conditioning with regular flexibility and strength exercises that emphasize your leg and hip muscles.
  • Work to maintain balance and agility with focused exercises and drills.
  • Gradually incorporate changes, such as increases in miles run or changes to uphill terrain, to your running program.
  • Wear well-fitting shoes in good condition to reduce stress on lower extremity joints.
  • Get fitted for orthotics (shoe inserts) to counter faulty positioning due to knock knees or flat feet.
  • Wear a properly fitted knee brace to reduce strain on the inside of the knee joint.

Summary

Pes anserine bursitis is a problem that causes pain and swelling of the pes anserine bursa.

This problem results from overuse, damage, or disease. Athletes, older people, and those whose jobs require redundant movements are most at risk for this problem. It is also common in women of middle age who are higher than their healthy weight.

You can reduce your risk of having this problem by warming up before sports and learning the proper position of your knees. Handling underlying problems like diabetes can also help you avoid this issue.

Most people can recover and return to normal life after proper treatment. If you have a high risk of the problem, you may have to alter or avoid certain sports or movements to remain safe.

A Word From Verywell

Early diagnosis and proper treatment can give you the best chances of healing from pes anserine bursitis. While this condition can be easily treated, it's important to work to avoid recurrence. The pain of pes anserine bursitis can interfere with your ability to move normally and maintain your quality of life.

Pes anserine bursitis is usually a temporary condition. However, repeated flares that involve pain, swelling, and tenderness are signs of chronic bursitis. This can lead to a limited range of motion and eventual weakening of the muscles around the affected joint. Taking proper precautions can help you decrease your chances of having this problem.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Johns Hopkins. Bursitis.

  3. OrthoInfo. Pes anserine (knee tendon) bursitis.

  4. American Academy of Orthopaedic Surgeons. Pes anserine (knee tendon) bursitis.

  5. Bringham and Women's Hospital. Standard of care: pes anserine bursitis.

  6. American Physical Therapy Association. Physical therapy guide to pes anserine bursitis.

  7. American Association of Hip and Knee Surgeons. Home therapy exercises for pes anserine bursitis.

  8. Mitchell JJ, Chahla J, Vap AR, et al. Endoscopic trochanteric bursectomy and iliotibial band release for persistent trochanteric bursitisArthrosc Tech. 2016;5(5):e1185-e1189. doi:10.1016/j.eats.2016.07.005

By Anna Giorgi
Anna Zernone Giorgi is a writer who specializes in health and lifestyle topics. Her experience includes over 25 years of writing on health and wellness-related subjects for consumers and medical professionals, in addition to holding positions in healthcare communications.