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