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©2013 UpToDate ® Print Email Anserine bursa injection The patient lies on the back with the leg extended and externally rotated. The tibial tubercle, medial joint line, and midline of the medial lower leg are identified and marked. Ethyl chloride is sprayed on the skin. A 22-gauge needle is inserted perpendicular to the skin and is directed slightly upward toward the concavity of the medial tibial plateau. It is passed through the subcutaneous fat until the subtle resistance of the conjoined tendon is felt. Local anesthetic (1/2 mL) is injected for comfort. Then the needle is gently passed an additional 3/8" to the firm periosteum of the tibia and immediately withdrawn 1/8" to avoid injection into the medial collateral ligament. The bursa is located between the MCL and the tendon, and 1/2 mL local anesthetic plus 1/2 mL methylprednisolone (80 mg/mL, Depo Medrol) is injected. Injection should be free flowing with little resistance; pressure on injection usually suggests improper position (too deep). Courtesy of Bruce C Anderson, MD. Femur Tibia