TITLE:
Combined Ultrasound-Guided Pes Anserine Hydro Dissection and Intra-Articular Knee Injection for Multi-Source Knee Pain: A Case Report
AUTHORS:
Marium Javed, Dominic C. Harmon
KEYWORDS:
Knee Pain, Pes Anserine Bursitis, Hydrodissection, Ultrasound-Guided Injection, Dextrose 5%
JOURNAL NAME:
Pain Studies and Treatment,
Vol.14 No.4,
October
22,
2026
ABSTRACT: Background: Joint including knee pain is a heterogeneous disorder in which pain does not necessarily correspond to a single structural abnormality. Periarticular disorders may coexist with intra-articular degeneration and can contribute to persistent joint pain. Pes anserine bursitis is associated with knee osteoarthritis and may be clinically difficult to distinguish from adjacent tendinopathy or other causes of inferomedial knee pain. Case Presentation: We present the case of a 42-year-old woman presenting to the pain clinic with chronic right knee pain with MRI proven tricompartmental osteo-arthritis, anserine bursitis and cartilaginous degeneration. The patient was experiencing substantial impairment in activity levels. Intervention: During a single treatment episode, ultrasound-guided pes anserine hydrodissection with 10 mL of 5% dextrose was followed by a separate intra-articular knee injection containing 9 mL of 0.25% bupivacaine, 40 mg triamcinolone and 20 mg sodium hyaluronate. The interventions were directed at the clinically concordant periarticular and intra-articular abnormalities. This combination offered both the expected benefits of steroid and hyaluronate, combined with additional targeted therapy of tendinous inflammatory change. Outcome: Following this intervention the patient exhibited substantial improvement in both reported pain scores and activity levels at initial two week and subsequent two-month follow-up. No complications were reported. Conclusion: Knee pain is a heterogeneous disorder in which pain does not correspond to a single structural abnormality. Combined treatment was followed by improvement in patient-reported pain and activity over two months. Because both interventions were delivered together, this case cannot determine the independent effect of 5% dextrose hydrodissection or establish an additive or synergistic benefit. Comparative studies with standardized functional outcomes are needed. Substantial, sustained improvement was achieved following interventions, with no complications, and further investigation into the potential synergy between these combined techniques in joint pain merits investigation.