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Ischial Bursitis

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Other Names

  • Ischio-gluteal Bursitis
  • Weaver's bottom
  • Tailor's bottom
  • Ischiogluteal Bursitis
  • Ischial Tuberosity Bursitis
  • Lighterman’s bottom

Background

History

  • First described by Frazer in 1932, who performed a surgical resection of a sea captain with 20 years of buttock pain[1]

Epidemiology

  • Ischial bursitis is uncommon and infrequently recognized
  • It is rarely described in the literature

Introduction

Illustration of the ischiogluteal bursa[2]

Etiology

  • Repetitive microtrauma
    • First seen in weavers and tailors who sat for long periods of sitting on hard surface
    • May also be due to repetitive activities, such as running, jumping, kicking, or climbing stairs
  • Less commonly due
    • Acute trauma (hemorrhagic bursitis)
    • Inflammatory diseases such as Rheumatoid Arthritis, Gout
    • Infection such as tuberculosis

Anatomy of the Ischial Bursa


Risk Factors

  • Occupations that require long periods of sitting or vibration
    • Weaving
    • Tractor-driving
    • Road equipment machines
  • Sports that involve long periods of sitting
    • Canoeing
    • Horseback riding
    • Wheelchair racing for paraplegic patients

Differential Diagnosis

Differential Diagnosis Hip Pain


Clinical Features

History

  • Pain is typically insidious in onset
  • Located in buttocks or gluteal area, posterior thigh
  • Pain is characterized as a deep ache
  • Worse with prolonged sitting, exercise, standing on toes, bending forward
  • Trouble sleeping at night
  • Patients may endorse trouble sleeping, reduced mobility

Physical Exam: Physical Exam Hip

  • Tenderness to buttock and specifically to the ischial tuberosity
  • May also have pain with passive flexion, inability to actively extend hip
  • They may have an antalgic gait
  • Rectal exam: may find tender area of bulging inflamed tissue on the lateral wall of the affected side

Special Tests


Evaluation

  • Primarily a clinical diagnosis, however imaging useful in mixed or unclear clinical picture

Radiographs

MRI

  • Findings
    • May demonstrate a cystic mass with pericystic fluid and a thin wall
    • Low or intermediate signal intensity on T1-weighted images
    • High signal intensity on T2-weighted images
    • mural nodules of the bursa which are enhanced after the IV administration of contrast

Ultrasound

  • Findings
    • Hypoechoic mass with an irregular, thickened wall
    • Compressibility suggests bursitis, while non-compressible structure may suggests other etiology

CT

  • Findings in limited case reports
    • Hypodense cystic mass adjacent to the ischial tuberosity[3]
    • Typically bursitis with central hypodense
    • Peripheral hyperdense areas

Classification

  • N/A

Management

Prevention

  • Horseback Riding
    • Ensure rider has a proper fitting saddle

Nonoperative

  • Primary treatment in the majority of cases
  • Medications including NSAIDS
  • Ice Therapy and Heat Therapy
  • Physical Therapy
    • Goal: correct strength and flexibility deficits
    • Increase strength
    • Stretch hamstrings
  • Avoidance of aggravating activities
    • Avoid activities that elicit pain such as running, climbing stairs
    • Avoid sitting for prolonged periods of time
  • Ischial Bursitis Cushion/ Padded cushion
    • Consider prescribing when patient can not avoid seated activities

Procedures

Operative

  • Indications
    • Non-responsive to conservative therapy
    • Suspect infection
  • Technique
    • Bursectomy (?)

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Activities may be resumed gradually once pain is resolved.
  • Returning prior to resolution of the pain may cause prolonged symptoms.

Prognosis and Complications

Prognosis

  • Needs to be updated, no published literature to guide prognostication

Complications

  • Chronic pain
  • Inability to return to sport

See Also

Internal

External


References

  1. Fraser I, Belf MC. A very large bursa. Lancet. 1932;219(5658):290–1.
  2. Lowe Taylor, Anita M., and Eugene Yousik Roh. "Hip: Periarticular Injections." Bedside Pain Management Interventions. Cham: Springer International Publishing, 2022. 675-688.
  3. Völk M, Gmeinwieser J, Hanika H, Manke C, Strotzer M: Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma. Eur Radiol 8:1140–1141, 1998.
  4. Wisniewski, Steve J., et al. "Ultrasound-guided ischial bursa injection: technique and positioning considerations." PM&R 6.1 (2014): 56-60.
  5. Shen, Zi-wei, et al. "Platelet-rich plasma for treatment of ischiogluteal bursitis Symbol." Journal of Clinical Rehabilitative Tissue Engineering Research 18.47 (2014): 7689-7696.
Created by:
John Kiel on 10 June 2019 17:10:18
Authors:
Last edited:
28 May 2023 14:39:48
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