Pelvis / Coccyx
Ischial Bursitis
좌골 점액낭염
Inflammation of bursa over ischial tuberosity ('weaver's bottom')
- How common
- Common in sedentary occupations
- Typical age
- All ages
What is it?
Bursa between ischial tuberosity and gluteus maximus inflames due to repetitive pressure/friction, causing swelling and pain.
Commonly affected: Bursa over ischial tuberosity
How it develops
- Repetitive PressureProlonged sitting on hard surfaces
- Bursal InflammationSynovial inflammation with effusion
- Bursal DistensionFluid accumulation enlarges bursa
- Adjacent Structures IrritatedPossible hamstring/sciatic irritation
Symptoms
- Worse with sittingEspecially on hard surfaces
- Focal ischial painPain over lower buttock bone
- Hamstring radiationDull radiation down posterior thigh
- Swelling/warmthLocal swelling (marked if septic)
- Worse on stairsWorse with hamstring loading
How it is examined
- Ischial tuberosity tendernessDirect tenderness over tuberosity
- Resisted hamstringPain with resisted knee flexion
- Sitting provocationSitting reproduces pain
- Rule out piriformisFAIR test differentiates piriformis
Imaging
X-ray usually normal; rules out calcification or spur.
- Usually normal
- Rare calcification
- Rule out spur
- Rule out avulsion
MRI/US shows bursal fluid and distension; excludes infection/tumor.
- Fluid adjacent to tuberosity (T2↑)
- Thickened bursal wall
- Peri-bursal edema
- Possible hamstring tendinopathy
Non-surgical care
- Cushion usePressure-relief cushion; avoid prolonged sitting
- NSAIDs / iceAnti-inflammatory
- PT / stretchingHamstring and gluteal stretching/strengthening
- Local steroid injectionUltrasound-guided bursal injection
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory chronic case, septic bursitis
Procedures that may be discussed
- Bursectomy (open or endoscopic)
- Drainage (if infected)
Outlook
Most resolve in weeks; pressure avoidance and stretching prevent recurrence.