Pes Anserine Syndrome and Bursitis in a Stroke Patient without Prior Knee Pathology: Diagnostic and Treatment-Learning Points

Abstract

Snapping pes anserinus is a cause of extraarticular medial knee snapping. It results from the translation of the semitendinosis or gracilis tendon during active knee flexion and extension. A 60-year-old female with left medullary infarct and no prior left knee pathology presented with left painful knee snap on walking 3 years after the stroke onset. Clinical examination detected a medial knee snap on the left knee extension. Dynamic ultrasound identified the semitendinosis tendon causing the knee snap. Magnetic resonance imaging of the left knee excluded intraarticular causes of knee snap and confirms soft-tissue edema and bursitis near the pes anserine. The patient was treated with local anesthetic injection and physical therapy with immediate pain relief. This case describes pes anserine syndrome in a stroke patient without prior knee pathology. Poststroke gait deviation can possibly cause repetitive excessive knee loading, leading to secondary musculoskeletal complications such as snapping pes anserinus.

Keywords

• knee
• pes anserinus
• snapping
• ultrasound