Abstract
Patients suffering from ischiogluteal bursitis frequently complain of pain at the base of the buttock with resisted extension of the lower extremity. The pain is localized to the area over the ischial tuberosity; referred pain is noted in the hamstring muscle, which may develop coexistent tendinitis. Patients are often unable to sleep on the affected hip and may complain of a sharp, catching sensation when they extend and flex the hip, especially on first awakening. Physical examination may reveal point tenderness over the ischial tuberosity. Passive straight leg raising and active resisted extension of the affected lower extremity reproduce the pain. Sudden release of resistance during this maneuver causes a marked increase in pain.
Keywords
iliopectineal bursitis, bursitis, pelvic pain, hip pain ultrasound guided injection, buttocks pain, diagnostic sonography, resisted hip injection test
ICD-10 CODE M70.70
Keywords
iliopectineal bursitis, bursitis, pelvic pain, hip pain ultrasound guided injection, buttocks pain, diagnostic sonography, resisted hip injection test
ICD-10 CODE M70.70
The Clinical Syndrome
The ischial bursa lies between the gluteus maximus muscle and the bone of the ischial tuberosity. It may exist as a single bursal sac or, in some patients, as a multisegmented series of loculated sacs. The ischial bursa is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries are often caused by direct trauma to the bursa from falls onto the buttocks or by overuse, such as prolonged riding of horses or bicycles. Running on uneven or soft surfaces such as sand may also cause ischiogluteal bursitis ( Fig. 91.1 ). If inflammation of the ischial bursa becomes chronic, calcification may occur.
Signs and Symptoms
Patients suffering from ischiogluteal bursitis frequently complain of pain at the base of the buttock with resisted extension of the lower extremity. The pain is localized to the area over the ischial tuberosity; referred pain is noted in the hamstring muscle, which may develop coexistent tendinitis. Patients are often unable to sleep on the affected hip and may complain of a sharp, catching sensation when they extend and flex the hip, especially on first awakening. Physical examination may reveal point tenderness over the ischial tuberosity. Passive straight leg raising and active resisted extension of the affected lower extremity reproduce the pain ( Fig. 91.2 ). Sudden release of resistance during this maneuver causes a marked increase in pain.
Testing
Plain radiographs of the hip may reveal calcification of the bursa and associated structures, consistent with chronic inflammation. Magnetic resonance and ultrasound imaging are indicated if disruption of the hamstring musculotendinous unit is suspected as well as to confirm the diagnosis ( Figs. 91.3 and 91.4 ). The injection technique described later serves as both a diagnostic and a therapeutic maneuver and is also used to treat hamstring tendinitis. Laboratory tests, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing, are indicated if collagen vascular disease is suspected. Plain radiography and radionuclide bone scanning are indicated in the presence of trauma or if tumor is a possibility.
