Procedure

Pes Anserine Bursa Injection

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Pes Anserine Bursa Injection, Pes Anserine Injection

  • See Also
  1. Knee Injection
  2. Joint Injection
  3. Injectable Corticosteroid
  4. Tendon Sheath Injection
  • Indications
  1. Pes Anserine Bursitis (early intervention)
  • Preparation
  1. Needle: 25 to 27 gauge (1 to 1.5 inch)
  2. Corticosteroid options
    1. Betamethasone (Celestone) 0.5 to 1 ml of 6 mg/ml
    2. Methylprednisolone (Depo-Medrol): 0.5 to 1 ml of 40 mg/ml
    3. Dexamethasone 4 to 8 mg
    4. Triamcinolone 10 to 40 mg
  3. Anesthetic: 2 ml
    1. Lidocaine 1% OR
    2. Bupivacaine 0.25 or 0.5%
  • Technique
  1. Images
    1. OrthoKneeInjectPes.jpg
  2. Position patient
    1. Patient lies supine with knee slightly flexed (at 10 to 20 degrees)
    2. May also be performed with patient seated and knee flexed to 90 degrees
  3. Ultrasound (optional)
    1. Linear probe (12 MHz) applied in coronal plane over the distal medial collateral ligament
    2. Target the pocket of fluid overlying the medial collateral ligament
  4. Mark position of pes anserine bursa (medial knee)
    1. Distal to medial joint line
    2. Sandwiched between ligament and tendon on medial knee
      1. Medial collateral ligament beneath bursa
      2. Medal thigh tendons (e.g. Sartorius) over bursa
    3. Identify point of maximal tenderness
    4. Also identified with patient's knee flexion against resistance
      1. Palpate the involved tendons
  5. Insert needle perpendicular to tibia
    1. Insert to bone and withdraw 3 mm
    2. Inject Corticosteroid
  • References
  1. Pfenninger (1994) Procedures, p. 1036-54
  2. Cardone (2003) Am Fam Physician 67(10):2147-52 [PubMed]
  3. Webb (2024) Am Fam Physician 109(1): 61-70 [PubMed]
  4. Zuber (2002) Am Fam Physician 66(8):1497-1500 [PubMed]