​Kembara Xtra - Medicine-Pes Anserine Syndrome

​Kembara Xtra - Medicine-Pes Anserine Syndrome  
Introduction
Sartorius, gracilis, and semitendinosus tendons all insert in the same place on the anteromedial tibia, forming the "goosefoot" or pes anserinus.
Between the semitendinosus tendon and the medical collateral ligament's tibial connection, under the pes anserinus, there is a bursa.
Inflammation of the bursa and/or tendons in this region causes pes anserine tendino-bursitis (PATB).

Prevalence and incidence of disease 

Prevalence
One of the most typical knee soft tissue pain symptoms 

Pathophysiology 
Overuse damage, excessive valgus and rotary strains, mechanical forces, and degenerative alterations are regarded to be the main causes of PATB. Direct injury

Risk Factors More prevalent in overweight, middle-aged women Additional risk factors include: Pes planus; genu varum
- Cycling, swimming ("breaststroker's knee"), and long-distance/hill running - Sports that include cutting or side-to-side motion (basketball, soccer, and racquet sports)

Osteoarthritis (OA) - Patients with symptomatic OA have a higher incidence of PATB; the prevalence of both conditions has been estimated at 75%; higher grades of OA are linked to a thicker pes anserine bursa and a greater region of bursitis; a medial meniscal rupture; and type II diabetes.

Most diagnoses are clinical diagnoses.

The most prevalent complaint is medial knee discomfort at the pes anserine insertion.
- The anteromedial aspect of the tibia, 4 to 6 cm below the medial joint line, is painful.
Knee flexion makes pain worse: - Climbing or descending stairs - Standing up from a chair or other seated position - Sitting cross-legged

clinical assessment 

- Palpable tenderness or localized swelling at the insertion of the pes anserine are typical symptoms. Warning: Tenderness on deep palpation will be present in this area in 30% of asymptomatic patients. Make sure to check both sides and link the physical examination to the past.
– When bending the knee against resistance, the pain gets worse.
Findings that point to a different diagnosis include joint effusion, discomfort along the joint line, locking of the knee, and systemic symptoms including fever. 

Differential diagnosis: Tibial stress fracture, septic arthritis, medial compartment OA, medial meniscal injury, medial collateral ligament injury, and medial plica syndrome.

Diagnostic tests and laboratory results

Initial Tests (Lab, Imaging): Mostly clinical diagnosis, no need for lab tests, no need for imaging unless there is concern for underlying bone damage/fracture, ligamentous injury, or meniscal tear.

Tests in the Future & Special Considerations
Although ultrasound (US) has a poor connection with clinical findings, it can show focal edema inside the pes anserine bursa and reveal underlying osteoarthritis. - The pes anserine complex does not exhibit any morphologic alterations on ultrasound in a large number of patients with a clinical diagnosis of pes anserine bursitis.
MRI: T2-weighted axial scans work well to detect bursa inflammation.
– The relationship between a clinical diagnosis of pes anserine bursitis and MRI radiographic evidence of pes anserine disease has not been thoroughly investigated.
– 5% of asymptomatic patients may have fluid in the pes bursa visible on an MRI. 

Management 

Pes anserine bursitis frequently resolves on its own. Most frequently, conservative therapy is used: 
Relative rest and altering activities to avoid aggravating motions, particularly knee flexion 
NSAIDs for pain management, ice to the affected area, physical therapy (PT) to strengthen the knees and treat any underlying pathologies 
Kinesio tape: According to one study, Kinesio taping is more efficient than PT with naproxen (Naprosyn) at reducing pain in PATB patients.

Injections of corticosteroids and physical therapy were found to be equally effective treatments for acute pain in PATB.
Due to the fast effect and potential for low PT compliance, steroid injections may be chosen in some circumstances. Consider administering a steroid injection at the pes anserine bursa as well if you have symptomatic OA because discomfort at the PATB can impair function in persons with both conditions.

 Weight loss to enhance knee biomechanical forces

The First Line of Medicine
Ibuprofen (800 mg PO TID) or naproxen (500 mg PO BID) are examples of nonsteroidal anti-inflammatory drugs (NSAIDs). - Inject using a conventional aseptic approach at the site of the greatest tenderness.
– A tiny (e.g., 25-gauge, 1-inch) needle is used to inject the anesthetic (i.e., 1% lidocaine) and steroid (i.e., 40 mg of methylprednisolone) into the bursa.
– Before injecting, slightly remove the needle after inserting it perpendicular to the skin until the bone is felt.
– Don't inject into the tendon directly.
Blind injection is inferior to US-guided injection.
Next Line
Injections of platelet-rich plasma can help reduce pain.

Stretching the hamstrings and Achilles, strengthening the quadriceps and adductor muscles, and extracorporeal shock wave therapy (ESWT) are further treatments that can help with PATB pain.


Surgery has no place in regular isolated instances, according to surgical procedures 
In severe or resistant situations, bursa drainage or removal may be employed.


Program for continuous care homes that focuses on strengthening and flexibility 

Diet
If obesity is a contributing problem, take into account dietary adjustments as part of a comprehensive weight-loss program.

Prognosis Conservative therapy is effective in the majority of pes anserine syndrome cases. Recurrence is frequent, and additional therapies can be necessary.