American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the appropriate management step when conservative measures for Pes anserine bursitis are ineffective?

1. Increased physical therapy

2. Glucocorticoid injection

3. Immediate MRI evaluation

4. Referral to orthopedics

The correct answer is: Glucocorticoid injection

In cases of Pes anserine bursitis, conservative measures typically include rest, ice application, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. If these conservative interventions fail to provide relief, a glucocorticoid injection becomes an appropriate management step. The rationale behind using glucocorticoid injections is their potent anti-inflammatory properties, which can effectively reduce inflammation in the bursa and alleviate pain. This approach is often employed as a next step when conservative measures have not achieved the desired results, providing rapid symptom relief and allowing for a return to functional activities. Increasing physical therapy may still be beneficial; however, it may not address the underlying inflammation directly if the bursitis is severe. Immediate MRI evaluation is typically not warranted unless there are concerns for other intra-articular problems or if the diagnosis is unclear after clinical evaluation. Referral to orthopedics is usually considered if the condition persists despite injections or if there are significant complications or concerns regarding diagnosis. Thus, glucocorticoid injection represents a targeted intervention aimed at controlling the primary inflammatory process when initial conservative strategies have been ineffective.