In pes anserine bursitis, which finding is typical in the history?

• A. Insidious onset of pain over the medial proximal tibial metaphysis approximately 2-4 cm below the joint line
• B. Pain with running or stairs
• C. May present with history of diabetes and obesity
• D. May be common in older adults 50-80 with knee OA

Answer: (B)

Pes anserine bursitis presents with medial knee pain that is tied to activity. The key historical clue is pain that occurs with activities that load the knee in flexion, especially running or climbing stairs, because repeated knee bending irritates the inflamed bursa at the pes anserinus insertion on the medial proximal tibia. Patients may have tenderness to palpation over that medial tibial area as well, but the defining history is the pattern of pain provoked by these activities. Obesity can be a risk factor, and knee OA can coexist, but the most characteristic historical feature remains pain with running or stairs.