Ischial tuberosity bursitis treatment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The ischial bursa separates the gluteus maximus muscle from the ischial tuberosity in the gluteal region ("the butt").

Inflammation commonly arises as a result of trauma or prolonged sitting on a hard surface (weaver's bottom).

Pain may radiate down the back of the thigh and resemble sciatic nerve inflammation; however, it can be reproduced by pressure over the ischial tuberosity.

This condition has been the subject of much intererst, particularly when it comes to imaging...

"Imaging features of ischial bursitis with an emphasis on ultrasonography."

Kim SM, Shin MJ, Kim KS, Ahn JM, Cho KH, Chang JS, Lee SH, Chhem RK.

Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnab-dong, Songpa-ku, Seoul 13-736, South Korea.

OBJECTIVE: The aim of this study was to evaluate the imaging features of ischial bursitis with an emphasis on ultrasonography (US). DESIGN AND PATIENTS: Our study included 31 patients with a painful mass or tenderness in their buttock who underwent US (n=27), CT (n=1), or MR imaging (n=4). A needle aspiration (n=6) or a bursal excision (n=5) was performed in those patients who had no clinical improvement in spite of the conservative treatment. Evaluation included lesion location, size, wall of the bursae, and intrinsic characteristics on US, CT and MR imaging. RESULTS: Ischial bursitis was superficial to the ischial tuberosity in all patients (n=31). The lesion ranged from 1.5 cm to 7 cm (average 3.8 cm) in diameter. The bursal wall was identifiable in 25 cases (81%). Internal septa and mural nodules were seen in 12 (39%) and 17 cases (55%), respectively. Sonography showed that fluid within the bursa was hypoechoic (59%), hyperechoic (26%), or of mixed echogenicity (15%). The bursae were compressible by the transducer. Power Doppler examination (n=7) showed hypervascularity of the bursal wall. All lesions imaged with contrast-enhanced CT and MR imaging had an enhancing thin wall and mural nodule. CONCLUSIONS: Ischial bursitis, superficial to the ischial tuberosity, can be clearly demonstrated on sonography and appears as a thin-walled cystic lesion, with or without internal septa and mural nodules.

Ischial bursitis may occur as a complication of an injury of the hamstring origin on the ischial tuberosity. Symptoms include pain while sitting and localized tenderness on examination.

Initial treatment consists of rest, ice, NSAIDs, hamstring stretching and strengthening, and protection. Often a doughnut cushion will alleviate the patient's symptoms while he or she is sitting. Aspiration of the bursa and injection of a corticosteroid should be considered for recalcitrant cases. Ultrasound-guided percutaneous needle tenotomy with autologous tissue grafting (platelet-rich plasma), a minimally invasive procedure, has been used with great success. Rarely, surgical excision of the bursa for persistent pain and disability is indicated.

Ischial bursitis is not the same as ischial tuberosity syndrome. The ischial tuberosity is a part of the bone in the frontal portion of the ischium, the lowest of the three major bones that make up each half of the pelvis.

As the intersection of the ischium and the pubis, it is attached to various muscles and supports the weight of the body when one is sitting. Ischial tuberosity pain may be experienced by a wide range of athletes, including soccer players, cyclists, baseball players, figure skaters, cheerleaders and any type of jumpers or runners. It is often misdiagnosed as ischial bursitis.

The ischial tuberosity is the point of origin of the adductor and hamstring muscles of the thigh, as well as the sacrotuberus ligaments.

The symptoms of ischial tuberosity pain are pain in the buttock, especially when sitting and running. The area may also be quite tender and sensitive to touch.

Physical therapy, rest, anti-inflammatory medicines, injection with glucocorticoids, and ultrasound-guided percutaneous needle tenotomy with autologous tissue grafting (platelet-rich plasma) may help.

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