Ischial bursitis is an inflammatory strategy of the bursa that sits within the buttocks between the ischial tuberosity and the gluteus maximus. It presents with buttocks or thigh ache which classically is made worse with lengthy intervals of sitting. Most sufferers will enhance with conservative remedy, particularly with exercise modification when the trigger is occupational.
The ischial bursa is positioned deep to the gluteus maximus muscle over the ischial tuberosity. The synovial bursa consists of a fatty connective tissue capsule full of synovial fluid. Muscle attachments embrace the semimembranosus, semitendinosus and the lengthy head of the biceps femoris. The ischial tuberosity is especially weak is it as weight beraing stress level when seated.
Danger elements embrace a sedentary life-style and occupations that embrace lengthy intervals of sitting or vibration reminiscent of weaving, tractor driving and highway tools machines. Equally, sports activities that embrace lengthy intervals of sitting enhance the chance reminiscent of canoeing, horseback driving and wheelchair racing occasions for paraplegic athletics.
Sufferers report an insidious onset of ache positioned within the buttocks, gluteal or posterior thigh. It’s sometimes described as a deep ache. It may be made worse by extended sitting, train (working, leaping, kicking, stairs), standing on toes and bending ahead. Sufferers typically have hassle sleeping at night time. The ache may additionally be worse with passive hip flexion or lively hip extension
On bodily examination, tenderness to the buttock and ischial tuberosity is essentially the most dependable examination discovering. They could even have painful passive flexion and lack of ability to actively lengthen the hip. Gait might be antalgic. IF a rectal examination is carried out, the examiner could discover a tender space of bulging infected tissue on the lateral wall of the affected aspect. It is usually vital to contemplate an in depth again and/or knee examination relying on the scientific image. The straight leg increase take a look at and FABER could also be optimistic, though these are non particular.
Though the analysis is primarily scientific, imaging is commonly obtained as a part of the workup, particularly if the analysis is unclear. Radiographs are a screening software which are sometimes regular, nevertheless gentle tissue swelling and calcifications might be seen. MRI is the diagnostic gold commonplace as a result of it could actually rule out different etiologies reminiscent of malignancy. MRI findings embrace a cystic mass with peri-cystic fluid, hyperintense sign with fluid assortment on the bursa amongst different findings. Ultrasound may also be used which can demonstration a hypoechoic mass with an irregularly thickened wall which is usually compressible.
Administration is primarily conservative. First line remedy consists of discontinue or modification of offending actions which might be inflicting or eliciting the ache. NSAIDS, ice remedy, warmth remedy must also be launched. Bodily remedy is a cornerstone of care with an emphasis on constructing energy and correcting deficits in flexibly. An ischial bursitis cushion can be utilized sufferers the place “avoiding sitting” will not be actually an choice. In sufferers who don’t enhance with first line remedy, an ischial bursa corticosteroid injection might be carried out underneath ultrasound steerage. Surgical intervention must be thought of in sufferers who should not responding to conservative administration or the place an infection or malignancy are suspected.
As a result of dearth of literature, there are not any broadly accepted rehabilitation protocols. It’s the opinion of this writer {that a} hamstring rehab protocol can be an affordable surrogate. Return to play is guided by decision of signs. If athletes return to play too early, they’re prone to lengthen their signs. There isn’t a steerage on prognostication. Issues embrace continual ache and lack of ability to return to sport.
In abstract, ischial bursitis is a pathologic inflammatory situation of the bursa between the ischial tuberosity and gluteus maximus. It’s poorly described within the literature and certain underdiagnosed. The analysis is primarily scientific with the one particular function being level tenderness on the ischial tuberosity. Imaging research are primarily adjunct to rule out different causes in sufferers who should not enhancing or the scientific image is unclear. Administration is primarily conservative together with exercise modification, warmth, bodily remedy, ischial bursa cushion and, much less generally, a corticosteroid injection of the bursa.