Causes and findings:
• Overuse - especially dancers or runners
• Pain just proximal to insertion of medial flexors of knee
• Painful: resisted flexion of knee
Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml
Anatomy:
The pes anseurine is the combined tendon of insertion of the sartorius, gracilis
and semi-tendinosus. It attaches on the medial side of the tibia just below
the knee joint line. The bursa lies immediately under the tendon just posterior
to its insertion and is extremely tender to palpation in the normal knee.
Technique:
• Patient sits with knee supported
• Identify the pes anseurine tendon by making patient strongly flex knee against resistance. Follow the combined tendons distally to where they disappear at insertion into tibia. The bursa is found as an area of extreme tenderness slightly proximal to the insertion
• Insert needle into centre of tender area through tendon until it touches bone
• Deposit solution in bolus
Aftercare:
The patient should avoid overuse activities for at least 1 week, when graded stretching and strengthening exercises are started.
Comments:
It is important to remember that the bursa is extremely tender to palpation on everybody, so comparison testing must be done on both knees.
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