![pes anserinus pes anserinus](https://physioworks.com.au/wp-content/uploads/2020/07/pes-anserine.png)
Pompan recommends a palpation-guided injection with corticosteroid. Much like the treatment for the inaccurate diagnosis of “greater trochanteric bursitis”, Dr. Pompan’s article he nicely points out the lack of objective findings of a bursitis noted in most patients with tenderness over the medial tibial flare in prior MRI and ultrasound studies. Pompan perpetuates the myth that tenderness over this area is consistent with a “bursitis” similar to the ongoing inaccurate diagnosis of “greater trochanteric bursitis”, in patients suffering from lateral hip pain. This is likely due to mechanical overload of these tendons on the medial side of the knee joint where there is loss of joint space. In my experience, insertional tendinopathy of the pes tendons is quite common and often seen in patients suffering from medial knee joint osteoarthritis. He also nicely describes the issues regarding treating patients with knee pain based upon imaging studies and the now numerous studies pointing out the lack of efficacy and potential for progression of arthritis with arthroscopic meniscal debridement surgeries. He nicely points out the concerns for a diagnosis whose basis relies on imaging studies rather than upon the history and physical examination. Pompan makes several valid points regarding this often-missed area of knee pain in this population. Donald Pompan in the September issue of Lower Extremity Review. It was with great interest that I reviewed the article, “Pes Anserine Tendino-Bursitis: An Underdiagnosed Cause of Knee Pain in Middle-Aged and Older Patients,” by Dr. Pes Anserine Tendino-Bursitis: An Underdiagnosed Cause of Knee Pain in Middle-Aged and Older Patients. It should be noted that in cases in which the patient is morbidly obese, “puckering” of the tissues may be required to reach the bone (Figure 4). Then, without removing the needle, steroid (80 mg Kenalog) from a second syringe is injected around the bone (Figure 3). Lidocaine (5cc of 1% lidocaine) in one syringe is injected into the subcutaneous and deeper layers all the way to bone (Figure 2). The injection is done using a 1 1/2-inch-long 22-gauge needle with an entry angle of approximately 45 degrees to the coronal plane of the tibia angling from anteromedial to posterolateral (Figure 2). In terms of the injection technique, the goal is to inject the bony periosteum in the area of maximal tenderness, which is consistently found in the same location, as described above. This site appears to correspond to where the gracilis and sartorius tendons converge as they begin their attachment to the tibia, as seen in the anatomical study by Lee et al. While the pes anserine bursa has been shown to occupy the bulk of the proximal medial tibia, the area of maximal tenderness is palpable with the tip of the index finger in the same specific location − slightly posterior to the middle of a line drawn between the apex of the knee flexion crease and the tibial tubercle (Figure 1).
![pes anserinus pes anserinus](https://healthsaline.com/wp-content/uploads/2015/11/location-of-pain-feel-in-pes-anserinus-bursitis.jpg)
FOR REFERENCE: Pes Anserine Tendino-Bursitis Injections Figures