Local Corticosteroid Injection Research Articles

A Comparative Study of Effectiveness of Splinting and Splinting Plus Local Corticosteroid Injection in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial.

Introduction Corticosteroidinjection and wrist-hand splint are two of the most commonly used conservative options for the management of carpal tunnel syndrome (CTS). This study compares the effectiveness of splinting and splinting plus local steroid injection in improving clinical and nerve conduction findings of patients with CTS. Methods A total of 44 patients with CTS were randomized into two groups. Group A used a full-time neutral wrist splint and group B was injected with 20 mg of triamcinolone acetonide and was given a full-time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients were evaluated at baseline, 4 and 12 weeks after interventions. The chi-square test was used to test the association of different study variables. Z-test was used to test the significant difference between the two proportions. The meanswere compared by t-test. ANOVA was used to compare more than two mean values. Results The mean difference of the Boston Carpal Tunnel Questionnaire and median nerve latency at baseline and 12th week after treatment was significantly higher in group B than in group A (p<0.05). In intragroup comparison, there was significant improvement in the patient satisfaction, and clinical and nerve conduction values between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P< 0.01).However, the inter-group comparisons were not significant. Conclusion Both of the management methods (splinting plus corticosteroid injection and splinting) have significant effects on the improvement of symptoms, and functionaland nerve conduction status. It seems that splinting plus corticosteroid injection has a little edge over splinting alone during the follow-up periods.

Effectiveness of corticosteroid injection vs platelet rich plasma (PRP) injection in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is one of the most common causes for inferior heel pain in adults. Many noninvasive and invasive treatment modalities are available for its treatment. Local injection of corticosteroid and Platelet-rich plasma (PRP) is usually used in the treatment of chronic plantar fasciitis not responding to noninvasive conservative treatments. Objectives: To compare the efficacy of local injection of corticosteroids and platelet rich plasma (PRP) in the treatment of plantar fasciitis. Methodology: Patients diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study and randomly allocated into 2 groups of 38 each (Group A and Group B). Patients were treated with local corticosteroid injection in group A and autologous PRP injection in group B. Clinical assessment was done prior to the injection and at 3 weeks and 3 months following the injection, which included visual analog pain scale (VAS), subjective rating using the modified Roles and Maudsley score (MRMS), functional outcome score by the Foot function Index (FFI). Results: The mean age, sex and body mass index was comparable for both groups. Postinjection, there was significant improvement (p &lt; 0.05) of visual analog score (VAS), modified Roles and Maudsley score (MRMS), Foot Function Index in both the groups. However, there was no significant difference (p &gt; 0.05) in improvement of VAS, MRMS and FFI when compared between the 2 groups. Conclusion: This study revealed that the treatment of plantar fasciitis with steroid or PRP injection was equally effective in patients who do not respond to conservative treatment.

Atraumatic Sport-Related Medial Sesamoid Pain: Conservative Treatment Outcome and Magnetic Resonance Imaging Features.

This study aimed to evaluate the effectiveness of conservative treatment in selected patients with atraumatic medial sesamoid pain (MSP) that developed during sports activities. The secondary aim was to determine the detailed underlying pathology in patients who did not respond to conservative treatment using magnetic resonance imaging (MRI). From March 2015 to August 2022, we prospectively followed 27 patients who presented to our outpatient clinic with atraumatic sports-related MSP. The conservative treatment protocol for MSP included the use of oral analgesics, activity restriction, insole modification, local corticosteroid injections, and boot walker application with crutches. MRI was performed for all patients who experienced persistent pain despite the completion of conservative treatment. After the completion of the conservative treatment protocol, 48.1% of the patients reported a reduction in pain. Patients with younger age at pain onset (p = 0.001), higher body mass index (p = 0.001), and a bipartite medial sesamoid (p = 0.010) were more likely to experience persistent pain after conservative treatment. The type of sports activity was also a factor since running- and dancing-related MSP tended to respond better to conservative treatment compared to MSP originating from golf, futsal, and weightlifting with squatting. On MRI, 42.8% of patients showed no specific abnormal findings, with signal changes in soft tissues such as the subcutaneous fat and bursa being the most common, followed by intraosseous signal changes of the medial sesamoid bone and chondral or subchondral lesions of the medial sesamoid metatarsal joint (28.6% each). Conservative treatment was successful in less than half of the patients who experienced MSP due to sports activity. Practitioners should be aware of the numerous possible causes of conservative treatment failure, such as bursitis, medial sesamoiditis, stress fracture, or chondral lesions between the medial sesamoid and metatarsal. MRI evaluation may be helpful in MSP patients who do not respond to conservative treatment.

Chapter 13 - Piriformis syndrome

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

Comparative study between ultrasound-guided local injection of corticosteroid and shockwave in treatment of greater trochanteric pain

Comparative study between ultrasound-guided local injection of corticosteroid and shockwave in treatment of greater trochanteric pain

Effects of Extracorporeal Shock Wave Therapy in Patients with Mild-to-Moderate Carpal Tunnel Syndrome: An Updated Systematic Review with Meta-Analysis

Background: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome, primarily affecting women between the ages of 40 and 70, and conservative treatments are the first option for mild-to-moderate CTS. However, the comparisons between extracorporeal shock wave therapy (ESWT) and other non-surgical methods in the treatment of mild-to-moderate CTS remain controversial, and an updated systematic review is needed. Methods: An electronic search was performed, and all available articles until August 2023 were included in the analysis. The overall quality of evidence was assessed by the GRADE approach. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: A total of 19 RCTs were included. Low-level quality evidence showed that ESWT outperformed the control intervention in terms of functional improvements, pain relief, electrodiagnostic parameters, and cross-sectional area of the median nerve at any time point of follow-up. Compared to local corticosteroid injection (LCI), there were statistically better improvements in functional improvements, pain relief, and electrodiagnostic parameters at 3 and 6 months of follow-up. Conclusions: There is low-level quality evidence to show that both fESWT and rESWT are more clinically effective than controls in symptom relief, functional enhancement, and electrophysiologic parameters’ improvement for patients with mild-to-moderate CTS at any time point of follow-up. Compared with LCI, ESWT yielded similar short-term (&lt;1 month) but better medium- (1–6 months) and long-term (&gt;6 months) improvements in pain relief and functional recovery with fewer potential complications.

Extra-corporeal shock wave therapy versus local corticosteroid injection in treatment of chronic trigger finger in diabetic patients

BackgroundTrigger finger is one of the most common causes of pain and dysfunction. The aim of our study was to compare the effectiveness of shock wave therapy versus local corticosteroid injection in the treatment of trigger finger in diabetic patients.ResultsThe two groups were matched on age, HbA1c, VAS score, and grip force at week zero. There was statistically significant improvement in both groups after treatment. In comparing the two groups after 6 weeks of starting treatment either by shockwave therapy or by local corticosteroid injection, there was a statistically significant improvement in group 1 as regards VAS pain score (p = 0.012), clinical signs (finger extension and locking) (p = 0.018), hand grip dynamometer (p < 0.001), and musculoskeletal ultrasound findings in comparison to group 2.ConclusionTrigger finger is a common complication of DM. Shockwave therapy was able to reduce pain and improve hand functional level and quality of life. Shockwave is an effective, safe, non-invasive method for conservative management of trigger finger.

Achilles tendon rupture prevention in physical activity and sports: predisposition factors

Objective: to summarize all clinically significant factors determining the Achilles tendon predisposition to rupture.Materials and methods: the basis of this scientific-analytical review was the analysis of data from the electronic portals PubMed-NCBI, Google Academy, and “Scientific electronic e-Library.ru”.Results: the presented literature review indicates that injuries and ruptures of the Achilles tendon can be provoked by numerous factors, among which genetic predisposition, individual anatomico-morphological features of the tendon complex structure, initial connective tissue failure, pathological changes in the Achilles tendon structure itself, foot and ankle deformities are of great importance. Men are more susceptible to this injury. Tendon injuries are most common either in 30–40 years, or in the period from 60 to 80 years. Professional athletes and people who lead sedentary lifestyles and do not exercise properly are at risk of Achilles tendon ruptures. Concomitant metabolic disorders and use of some medications also play an important role in the predisposition to this injury. Local corticosteroid injections pose a particular tendon rupture risk. The combination of several established factors significantly increases the likelihood of this emergency.Conclusions: early detection of predisposition to Achilles tendon rupture will allow timely development of effective measures for its prevention in physical training and sports.

Comparing the Efficacy of Local Corticosteroid Injection, Platelet-Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study.

Pes anserine bursitis (PAB) is one of the most common causes of painful knee syndromes. This study aimed at examining the efficacy of local corticosteroid injection, platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and enhance function in patients with pes anserine bursitis (PAB). A prospective, randomized, comparative study was conducted on 180 patients diagnosed with chronic PAB. They were equally divided into three groups as follows: Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml; Group II received a PRP injection; and in Group III, ESWT was used. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie articular index (RAI) for tenderness, which were recorded at the baseline, after 1 week, and after 8 weeks. Before the application of procedures, there was a statistically significant increase in the WOMAC pain score in the local corticosteroid group compared to the PRP group and the ESWT group (P < 0.001). After the application of procedures, there was a statistically significant improvement in the 1-week and 8-week WOMAC pain score, WOMAC physical function score, and VAS in the local corticosteroid group in comparison to the PRP group and the ESWT group. (P < 0.001). Moreover, RAI for tenderness shows statistically significant improvement at 8 weeks in the local corticosteroid groups compared to the PRP groups (P < 0.001) and ESWT groups (P < 0.001). Similarly, a statistically significant difference was found between the PRP and ESWT groups (P=0.023). Our data suggest that in patients with PAB, local corticosteroid injection is more efficient than PRP injection and ESWT for reducing pain and enhancing function.

Does local injection of long acting corticosteroid improve postoperative outcome of hypospadias repair? A randomized controlled trial

PurposeTo assess the safety and efficacy of local corticosteroid injection during hypospadias repair.MethodsBetween May 2021 and March 2023 children less than 10 years who were admitted for hypospadias repair were divided by random allocation into two groups. We injected local corticosteroid 2 ml proximal to coronal sulcus in group A while in group B we didn’t. All types of hypospadias were included in the study. We excluded patients older than 10 years and those with pre-existing complicated hypospadias (multiple fistulae and multiple surgeries), or bleeding diatheses. Pre-operative, intraoperative and postoperative variables were compared between the two groups.ResultsA total of 120 patients (60 in each group) were enrolled in the study. The mean ages and preoperative variables were not significantly different. The site of hypospadias and the type of surgery were comparable in both groups. (Table) There were no significant differences between both groups regarding average blood loss and operative time in each type of surgical repair. There was a significant higher incidence of intraoperative and postoperative penile oedema in group B (P-value < 0.001) while the incidence of skin discolouration was higher in group A. Postoperative complications, described as Clavian classification, were significantly higher in group B. The incidences of superficial skin infection, meatal stenosis, urethral fistula, and recurrence with the need for redo repair were significantly higher in group B (P-value: 0.002, 0.018, 0.032, and 0.001, respectively).ConclusionLocal corticosteroid injection during hypospadias repair minimize the penile oedema and decrease the incidence of postoperative functional and cosmetic complications.

Comparison of autologous platelet-rich plasma and corticosteroid injection in the treatment of chronic plantar fasciitis

Chronic plantar fasciitis is one of the leading causes of heel pain and medical professionals can find it difficult to treat successfully over the long term. Due to any factor which increases tension on the medial calcaneal tuberosity insert (e.g., running, walking, prolonged standing, pes cavus, pes planus, overpronation), results in local inflammation. While the results of the use of platelet-rich plasma to treat chronic plantar fasciitis were encouraging, there is little documentation that compares the long-term effectiveness of chronic plantar fasciitis with steroid injection. It stimulates wound healing, bone healing, and tendon healing by releasing platelet-derived growth factors. This prospective randomized study is conducted to compare the efficacy of platelet-rich plasma and local injection of corticosteroid.

The Effectiveness of Using Laser Therapy on Outcome of Carpal Tunnel Syndrome Patients : A Literature Review

Carpal Tunnel Syndrome (CTS) is a neuropathy caused by compression of the median nerve that passes through the carpal tunnel structure in the wrist. If the CTS condition is not treated, complications will occur such as irreversible damage to the median nerve resulting in permanent impairment and disability, chronic wrist pain, and muscle atrophy and weakness. Currently there are various CTS therapies such as splinting , local injection of corticosteroids, oral medications such as prednisone, physical therapy such as carpal bone mobilization, ultrasound therapy , and nerve glides exercises , as well as surgical therapy. However, these various therapies have not provided optimal results and there are complications such as neuromas, hypertrophic wounds, dysesthesia, wrist joint stiffness, and the inability of various to reduce CTS symptoms. Therefore, more effective therapy with minimal side effects is needed. Therefore, in this literature review, an analysis of the effect of laser therapy on various outcomes of CTS patients as an innovative therapy was carried out. Study searches were performed on various databases such as Pubmed, ScienceDirect , Directory of Open Access Journal , Epistemonikos, and Cochrane Library . From the search results obtained a total of 389 studies. The 7 studies that met the inclusion and exclusion criteria were the studies that were analyzed in this literature review. Various types of laser therapy showed better outcome results than the control group, with LLLT laser therapy showing the best results in various outcomes in CTS patients. LLLT laser therapy also shows better results when combined with other types of therapy. No adverse events were reported with any type of laser therapy in all inclusion studies. Therapy is the newest type of innovative therapy with better effects and minimal side effects compared to conventional therapy in CTS patients.

Terminating Corticosteroid Injection in Tendinopathy? Hasta la Vista, Baby.

SYNOPSIS: Two recent randomized-controlled trials showed promising results of local corticosteroid injections combined with exercise therapy for Achilles tendinopathy and plantar fasciopathy. Should clinicians go back to using corticosteroid injections to treat tendinopathy? Are corticosteroids back (baby)? In this viewpoint we critically appraise the new evidence and humbly share our clinical reasoning when advising athletes about corticosteroid injections in practice. Our goal is to help clinicians decide what to do and what to recommend to patients. We prioritize the risk for higher recurrence rates and tendon rupture when weighing the reasonable treatment options for tendinopathy, and recommend against using corticosteroid injections. The best systematic review evidence shows that local corticosteroid injections are not effective for tendinopathies after the first few weeks, and produce worse long-term outcomes compared to other treatments. For now, we consider corticosteroid injections remain terminated. J Orthop Sports Phys Ther 2023;53(11):1-4. Epub: 28 July 2023. doi:10.2519/jospt.2023.11875.

Comparative study of local injections of autologous platelet rich plasma versus corticosteroid in management of chronic plantar fasciitis

BackgroundPlantar fasciitis is a known degenerative pathology and is a common cause of heel pain. We intend to evaluate the efficacy between locally injected Corticosteroids and autologous PRP in the management of chronic plantar fasciitis patients. Materials and methodsIn this prospective randomized controlled study, 70 chronic plantar fasciitis with failed conservative management for 3 months were randomly selected into 2 groups of 35 patients each. Group A received a local autologous platelet rich plasma injection of 3 ml and group B received a local corticosteroid injection of 2 ml. The Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between the groups at 15 days, 1 month, 3 months and 6 months. ResultsNo improvement in pain between autologous PRP and corticosteroids study subjects was noted in the initial period up to 15 days whereas after 1 month, 3 months and 6 months duration, it is seen that autologous PRP injected study subjects showed significant relief in pain compared to corticosteroids. ConclusionPRP was more effective in chronic plantar fasciitis patients compared to corticosteroids with pain relief coming after first 1st, 3rd and 6th month of the injection. Level of evidenceLevel 2.

Synergistic effect of LCI with ESWT on treating patients with mild to moderate CTS: a randomized controlled trial

BackgroundApplying radial extracorporeal shock wave therapy (R-ESWT) with LCI(local corticosteroid injection) in carpal tunnel syndrome (CTS) management is gaining momentum. The objective is to actualize the topic of this study.MethodsIn this prospective randomized controlled trial, forty patients with mild to moderate CTS are divided into two sham- R-ESWT and R-ESWT groups subject to LCI(local corticosteroid injection). The first group received four sessions of sham-ESWT weekly, which involved sound but no energy; the second group received R-ESWT at equal intervals and were assessed for pain score (VAS score) and symptoms (GSS) baseline, 1st month, 3rd month, and 6th month.ResultsA considerable improvement is observed in both groups for pain at (P < 0.05) and symptoms at (P < 0.05) in the 3rd month. The second group revealed more significant symptom improvement at (P < 0.05) in the 6th month.ConclusionThe R-ESWT + LCI combined therapy course is the first line of treatment in patients with mild to moderate symptoms and leads to control and reduction of symptoms and the need for surgery, thus a primary concern in CTS treatment with an orthopedist.

Extracorporeal Shock Wave Therapy versus Local Corticosteroid Injection and Platelet-Rich Plasma in The Treatment of Supraspinatus Tendinopathy

Extracorporeal Shock Wave Therapy versus Local Corticosteroid Injection and Platelet-Rich Plasma in The Treatment of Supraspinatus Tendinopathy

The temporal effect of corticosteroid injections into large joints prior to trigger finger release on infection

BackgroundTrigger finger may be treated with open surgical release. Local corticosteroid injections have also demonstrated success. Studies suggest recipients of flexor sheath corticosteroid up to 90-days prior to open surgery are at increased risk of post-operative infection. However, the possible link between large joints corticosteroid prior to trigger finger release remains unexplored. Therefore, this study aimed to provide complication risks for trigger finger release recipients after large joint corticosteroid. MethodsWe reviewed a national, all-payer database and examined patients who did not receive and did receive corticosteroid two, four, or six weeks prior to trigger finger release. Primary outcomes assessed were 90-day risk for antibiotics, infection, and irrigations and debridement. Multivariate logistic analyses compared cohorts using odds ratios with 95% confidence intervals. ResultsNo trends were found regarding antibiotic requirements, infection, as well irrigations and debridement within 90-days for recipients of corticosteroid into large joints two, four, or six weeks prior to open trigger finger release. Elixhauser Comorbidity Index, alcohol abuse, diabetes mellitus, and tobacco use were identified as independent risks for requiring antibiotics as well as irrigations and debridement (all Odds Ratios > 1.06, all p ≤ 0.048). ConclusionsPatients who underwent trigger finger release after receiving a corticosteroid into a large joint two, four, or six weeks prior has no association with 90-day antibiotics, infection, or irrigations and debridement. While the comfort levels for individual surgeons vary, optimizing these comorbidities prior to surgery is an important goal discussed with patients to lower risks for infections. RetrospectiveLevel III.

Cochrane Corner

This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering interventions for treating distal femur fractures in adults; ultrasound and shockwave therapy for acute fractures in adults; and local corticosteroid injection versus placebo for carpal tunnel syndrome.

Clinical Images: Cholesterol crystals bursitis.

The patient, a 45-year-old woman, was referred to the outpatient clinic with an effusion of her right olecranon bursa. She had a history of systemic sclerosis, liver cirrhosis, and autoimmune hepatitis that was treated with mycophenolate mofetil and prednisone. About 3 years ago, she started to develop an effusion of the right olecranon bursa. More recently she noticed white skin nodules, which turned out to be calcinosis cutis. There were no signs of arthritis on either clinical examination or imaging. An ultrasound of the right olecranon bursa was performed and revealed a tissue mass with hyperechogenic lesions within, which is compatible with crystal depositions (A). Analysis of the aspirate with the polarization microscope indicated the presence of cholesterol crystals (B; left: original magnification × 40; right: original magnification × 10). These crystals usually look like plates of glass, sometimes with a notch out of a corner. They are variably and mildly birefringent. Under polarized light, they may exhibit a stained-glass effect. Most cases of cholesterol crystals are associated with hyperlipidemia, yet our patient had normal lipoprotein levels and did not use cholesterol-lowering medication. Instead, increased local cell degeneration and/or increased lipid permeability in response to chronic inflammation might have contributed to the formation of cholesterol crystals in the olecranon bursa of our patient. Cholesterol crystals have been described previously just once in a patient with scleroderma, in the subcutis, mimicking calcinosis cutis (1). After failing local corticosteroid injections, the patient was finally referred to the orthopedic surgeon for surgical synovectomy. Cholesterol crystals in bursal fluid of a patient with scleroderma has not been previously reported, as most of the cases reported so far in patients with rheumatic diseases are concerning patients with rheumatoid arthritis (2). Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Efficacy of ultrasonography-guided compared to surface landmark-based corticosteroid injection for people with chronic pes anserine tendinitis or bursitis: a randomised controlled trial

Background/Aims One of the main aetiologies of patients' symptoms who have degenerative knee disease is pes anserine tendinitis or bursitis. Local corticosteroid injection is an effective treatment for chronic cases. The aim of this study was to compare the efficacy of an ultrasonography-guided corticsosteroid injection vs a landmark-based injection. Methods A total of 31 patients with clinical chronic (&gt;3 months) pes anserine tendinitis bursitis, confirmed by ultrasonography, were randomised into two groups. One group received a corticosteroid injection (40 mg triamcinolone acetonide) with ultrasonographic guidance, and the other group received a corticosteroid injection without ultrasonographic guidance. Participants and the assessor were blind to the type of procedure. Participants were clinically assessed using the Western Ontario and McMaster University knee questionnaire before and 2 weeks after the injection and a visual analogue scale before, 2 and 12 weeks after the injection. Results There were significant decreases for both groups in the visual analogue scale at 2 weeks and 12 weeks after the injection, with a superior decline in the ultrasound-guided group (mean difference: 60.00, P&lt;0.001 in ultrasound-guided group, and mean difference: 25.33, P&lt;0.022 in the surface landmark-based group). The Western Ontario and McMaster University questionnaire scores also demonstrated significant improvement in both groups, with no preferential difference between groups (mean difference: 26.87, P&lt;0.001 in the ultrasound-guided group, and mean difference: 22.20, P&lt;0.001 in the surface landmark-based group). Conclusions Steroid injection is an effective treatment to manage chronic pes anserine bursitis, and ultrasonography guidance may further improve clinical outcomes.