Ischial Tuberosity Bursitis is a condition commonly associated with occupations that demand extended periods of sitting. Know about the disorder, including its various symptoms, causes, diagnosis and treatment options.
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It is a condition marked by acute inflammation of the bursa that covers the Ischial tuberosity – the rough bony projection in the pelvis upon which one rests when in a seated position. The closed sac acts as a lubricating medium between tendons and the pelvic bone.
The condition has previously been referred to as “Tailor’s seat” or “Weaver’s bottom”.
The classical symptom of the condition is severe buttock or hip pain that increases when in contact with a hard surface. Affected patients exhibit localized numbness overlying the inflamed bursa and tingling sensation in the buttock that frequently radiates to the lower limbs. These sensations can be constantly experienced in one or both legs, along with muscle weakness.
Picture 1 - Ischial Tuberosity Bursitis
The condition causes more discomfort when a patient sits. Another presenting feature of the ailment is hip stiffness that particularly occurs after prolonged rest. Affected patients complain of loss of range of motion in the hips that typically occurs when trying to perform day-to-day activities like bending and climbing stairs. These symptoms may get worse at night, causing sleep disruption. In the case of septic bursitis, the skin over the underlying affected bursa turns red and is normally warm to touch. The area around the hip may appear swollen. However, these are usually the additional clinical manifestations of the condition and could be observed only in rare cases.
The ischial bursa is situated between the tendons and joints of the pelvis. The bursal sac provides protection to the tendons when they slide over the ischial tuberosity. It also keeps the gluteus maximus muscle and ischial tuberosity in the buttocks apart. An inflamed bursa fails to function properly when it undergoes inflammation, causing friction and intense pain in the hips. Injury to the hamstring muscles present in the posterior region of the thighs attributes to the shooting pain that begins from the lower pelvis.
Various factors extensively contribute to the development of the condition. Acute inflammation occurs when a hard blow to the top portion of the pelvis forces the blood to leak into the bursa. Overuse of the hamstring muscles is common in athletes and soccer players as they repeatedly carry out the same type of movements. Long distance running could affect the bursa in individuals who are usually not used to exercising. Sometimes, carrying huge loads can injure the hamstrings muscles. Medical experts consider obesity as the primordial cause of this condition as the Ischial tuberosity does not have the capacity to bear the excessive body weight. Bursal swelling may also be triggered when an individual sits for a long time without taking any periodic breaks to stand up. Constantly sitting in the upright position builds excessive pressure on the Ischial bursa that increases susceptibility to the inflammatory condition. On rare occasions, the bursa can become infected with bacteria. However, the probability of a bacterial attack is quite low, owing to the deep location of the bursa. Although, uncommon, the condition may arise in individuals with rheumatoid arthritis and gout.
The diagnosis of the condition involves evaluation of the symptoms that are clearly visible during a physical examination. Tenderness of the outer hip is the significant characteristic of the condition that helps physicians to define the exact cause of the persistent hip pain. As the clinical features of this inflammatory condition are similar to a host of bone and joint ailments, an X-ray can be obtained to rule out these disorders. MRI and CT scans deliberately look for a pelvic fracture or a tendon tear. The presence of bacteria can be confirmed by a simple blood test that gives the appropriate WBC count and erythrocyte sedimentation rate. Calcium deposits can be identified on an examination of the bursal fluid by using a procedure called aspiration.
Non-steroidal anti-inflammatory medications are given to reduce the constant bouts of hip pain. Cortisteroid injection is administered in case of unbearable pain. Infectious conditions, however, require intravenous antibiotic therapy. Surgical drainage and removal becomes essential when the bursa gets severely infected or injured.
Picture 2 - Ischial Tuberosity Bursitis Image
Non-specific treatment, comprising RICE (or rest, application of both heat and ice compresses, and elevation of the affected area) can quickly make the condition subside. Weight reduction, hamstring stretches and strengthening exercises are some of the self-care techniques that could prove effective in hastening the recovery period. Patients can attend physical therapy programs to regain mobility and return to their pre-injury level.
Direct pressure on the hip may lead to debilitating effects. The prevention of the condition is particularly aimed at avoiding activities that hold wide chances of causing inflammation of the ischial bursa. Exercising the hamstring muscles can greatly improve the flexibility and strength of the buttocks.
The condition responds positively to both conservative and drug treatment. Oral and intravenous medications can easily resolve the symptoms within a short span of time. Patients undergoing surgical treatment recuperate well without any major side effects.
The condition is less likely to result in any serious complications. However, lack of proper care and treatment can cause the ailment to turn chronic.