Ischiogluteal Bursa

In between the tuberosity of the ischium and the gluteus maximus lies the ischiogluteal bursa. Found in soft tissues in between the ischial tuberosity and the deep surface of the Gluteus Maximus, the posterior ischiogluteal bursa is an inconstant, adventitial bursa. Looking upon degenerative pathology of hamstrings tendons it is usually not visible and may become distended.

Function

The musculotendinous junction of the hamstring muscles from the ischial tuberosity is supported by it. It acts as a cushion.

Etiology

Etiologies consist of overuse syndromes (prolonged sitting), athletics, recurring falls (trauma), weight-loss, and debilitation.

Imaging/Radiology

• Plain film radiographs: There may be associated adjacent calcification and cortical irregularity of the included ischial tuberosity in a long term condition may be present.
• Ultrasound: nearby to the lower posterior medial element of the ischial tuberosity, ultrasound may demonstrate a fluid-filled sac. This may be having echogenic contents within it

Clinical Significance

Ischiogluteal Bursitis

• Weaver’s bottom was the name initially given to this bursitis.
• In people whose occupation requires prolonged sitting a sterilized inflammation of the bursa often develops.
• Ischiogluteal bursitis can happen because direct trauma, such as falling or a direct hit when the hip is in a flexed position.
• Ischiogluteal bursitis can be shown by Ultrasound as a superficial, hypo-anechoic fluid collection with lobulated margins (since the adventitial inception of such structure) and thick walls situated between the ischial tuberosity tendinous attachment of the hamstrings and the skin when the hips are bent and is a less regular condition.

Occurence

• The cause is similar to that of trochanteric bursitis.
• The pain usually looks like quickly as the ischium touches the chair and is relieved the minute the patient arises.
• The patient will mention pain with walking, climbing stairs, and flexion of the hip and trunk. Clinical and physical findings are pain and tenderness over or just above the ischial tuberosity.
• When ischioglutcal bursitis exists, patients typically refer pain over the midline of the buttock irradiating caudally along the hamstrings.
• Pain typically radiates into the hamstring muscles.

The primary causes which lead to recurring microtraumas and following inflammation of the bursa:

• Prolonged sitting on tough surfaces.
• Repetitive sport movements stressing the ischiogluteal bursa through the hamstring tendon,.
• Intense weight loss (e.g., cachexia).

Prevention

• Sitting must be minimized; chair padding, prostrate lying over a wedge (to give use of the hands), and other appropriate positioning to prevent aggravation of the bursa is most helpful.
• The patient might start a pain-free stretching program of the lower limb after the preliminary phase of treatment with anti-inflammatory medications and ice.

Ultrasound Diagnosis

• The pressure applied on the probe determines the squeezing of fluid bursal distentions, helping to differentiate bursitis from other pathological conditions, which mucinous material is not compressible such as paralabral cysts.
• Between gliding anatomical structures Ultrasound can quickly detect distention of the bursae around the hip, demonstrating a well – specified anechoic fluid collection.
• Bursal walls can thicken in chronic cases, or internal echogenicity can be present in rheumatic patients due to the existence of a synovial hypertrophy.
• Ischiogluteal bursitis is thought about as a less frequent condition with thick walls situated in between the ischial tuberosity tendinous insertion of the hamstrings and the skin when the hips are bent and can be depicted by Ultrasound as a superficial, hypo-anechoic fluid collection with lobulated margins (because the adventitial origin of such structure).