Pes anserine is basically also known as “Goose foot”, it is conjugation or amalgamation of three muscles that’s enters onto the anteromedial surface of the proximal extremity of the tibia bone.
The term bursitis means inflammation of bursae_the synovial-like cellular membrane overlying bony prominences_ may be secondary to the trauma, infection or such other condition as gout.
The most common and repeatedly occurring locations are subdeltoid, olecranon, ischial trochanteric, semimembranous-gastrocnemius(bakercyst), and prepatellar bursae
Before starting pes anserine bursitis treatment, the orthopedist must have to differentiate it from arthritis, because bursitis is more likely than arthritis to cause focal tenderness and swelling and less importantly to cause range of the adjacent joint.
Hence it is a tendon related issue so its treatment involves the following strategies.
A multidisciplinary approach is the most and widely followed. Patient education is essential.
Rest and abstention from the specific and associated physical activities for a period of days to weeks are essential. Once pain has reduced and subsided, a program of gentle exercise and stretching may prevent reoccurrences. Corticosteroid injection with lidocaine may be useful when intense discomfort is present. Basically corticosteroid injection is intra thecal(in joint) not IV or iM. Because clinical research articles with Meta analysis has indicated and shown that they have poor penetration in cause of IV or iM injection.
They could only be affective in case of minor inflammation to the other parts of the body. But when we talk about joint problems then treatment of pesanserine bursitis involve intra thecal injection of corticosteroids and lidocaine. Do remember lidocaine is used just because to avoid local pain due to insertion of needle.
And corticosteroids on nuclear receptors by blocking phosphor lipase A2 that leads to the inhibition of cascade of formation of COX and LOX mediators that’s causes pain and inflammation.
If the bursitis if just because of baker cyst that cause rupture of tissue in that case we need triamcinolone 20-40mg into the knee anteriorly, if it is not done so, then baker cyst may compress the vessels and cause leg edema and true thrombophelbitis.
Chronic, stable olecranon bursa swelling usually does not require aspiration. Aspiration of the olecranon bursa runs the risk of creating a chronic drainage site, which can be reduced by using a zig-zag approach with a small needle 25 gauge if available and possible, followed by pulling the skin over the bursa before is indicated only for cases in which there are reoccurrences of infection again and again due to baker cyst.
The best treatment involves the resting and digests system approach. First strategy is to avoid weight lifting so that the pressure could reduce.
Then to reduce the weight. Do remember too much rest and less contraction of Caff muscle may cause development of the deep vein thrombosis. So that’s why mild stretching and moderate exercise is essential for this treatment. Crackles by some cripinio doctor could also be helpful to reduce some symptomatic treatment.
This Article is Written By Dr Faran Ali Tariq
He is Quality Assurance inspector