Anserine bursitis
An under-diagnosed, easily treatable cause of knee pain
By Suzan M. Attar, MD
Printed with permission of the author.

The anserine bursa was initially called the no-name-no-fame bursa. The term anserine bursitis in use at present was coined by Moshcowitz in 1937, when he first described the condition (Handy, 1997).

The anserine bursa is located medially, 6 cm below the joint line between the attachment of the medial collateral ligament and the conjoined tendon (see Figures One and Two). Pe, anserinus means "goose's foot" and is the anatomic location of the conjoined tendons formed by gracilis, sartorius and semitendinosus muscles in the knee (West, 2002). This article will provide an overview, including the clinical presentation and management.

Presentation
There are several bursae surrounding the knee, three of which commonly become inflamed and cause knee pain:

• the anserine bursa, located on the inner side of the knee
• the prepatellar bursa, in front of the patella
• the two infrapatellar bursae, underneath the patella

Anserine bursitis is used loosely to describe pain over the medial aspect of the upper tibia. This could arise from the medial collateral ligament, the anserine bursa and the pes anserinus insertion (Hochberg et al., 2003).

Idiopathic bursitis occurs mainly in women because of their broad pelvic area, which results in angulation at the knee joint. putting more pressure on the pes anserine attachment. Secondary causes include medial compartment osteoarthritis of the knee, obesity, direct trauma, abnormal gait, tight hamstrings and, less commonly, overuse injury, as in athletics (Fireman, 2001).

Clinical symptoms
Pain is localized to a well-defined area on the medial knee region over the upper tibia. Patients often point to the spot with one finger. The pain can be bilateral and nocturnal. It's aggravated by climbing stairs. getting out of a chair and bending the knee. It may lead to the sensation of the knee "giving way."
Exam and investigations
On physical examination, upon palpation, tenderness is elicited about 5 cm to 6 cm below the medial joint line at the leNel of the tibial tubercle. There's no evidence of joint effusion. but there may be some slight swelling at the insertion of the medial hamstring muscles.

This abstract is a portion of the article which appears in the Winter 2007 issue of BodyCast.  
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