Best Practice Case Studies-Case 138 Asset 3 Ultrasound Evaluation of Pes Anserine Bursitis

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Video Summary

Dr. Mitchell Daugherty presented a detailed ultrasound case of pes anserine pain in a 22-year-old international collegiate athlete with a complicated history of left tibia/fibula fracture, nonunion, and later surgical repair with hardware. Although his lower leg pain improved after union, he developed persistent medial knee pain, tenderness at the pes anserine region, and pain with resisted knee flexion.<br /><br />The presentation reviewed a systematic ultrasound approach to the medial knee, including the MCL, medial meniscus, pes anserine tendons and bursa, patellar structures, suprapatellar recess, and posterior medial structures such as the semimembranosus and medial gastrocnemius. Normal anatomy, common pathology, and pitfalls like anisotropy were emphasized.<br /><br />In the case, ultrasound showed thickening and bursitis of the pes anserine complex, but the key finding was a proximal interlock screw from the tibial rod protruding from the cortex and irritating the tendons. Rather than injection, the patient was referred back to orthopedics for screw removal, after which his symptoms resolved.<br /><br />The discussion highlighted that true pes anserine bursitis is uncommon on ultrasound, though it may occur with hardware irritation, rheumatoid arthritis, or connective tissue disorders. Experts in the discussion also noted that fat pad thickening can mimic bursitis and that careful protocolized scanning helps avoid misdiagnosis.

Keywords

pes anserine pain

ultrasound

medial knee

hardware irritation

bursitis

tibial fracture

orthopedic surgery