Glucocorticoid injection in pes anserinus pain syndrome

Simulated injection of the anserine bursa. The injection site is best determined by following the tendinous posteromedial border of thigh (gracilis and semitendinosus), with the knee in semiflexion, to the tibia, where a mark is placed (pes anserinus insertion). The knee is then brought into extension and the needle is inserted at a 30-degree angle (distal to proximal), 3 cm proximal to the mark. An area about 3 cm in diameter is then injected, moving the needle back and forth, adjacent to periosteum (likely intrabursal), from the single initial entry. We use a 40 mg methylprednisolone mixed with 4 mL of lidocaine 2% without epinephrine in a 22-gauge needle and a 10 mL syringe.