Anatomy
The 3 large thigh muscles (hamstrings, hamstrings) have a common muscle tendon attachment on the ischial tuberosity (tuber ischiadicum). Beneath and between the tendon attachments are bursae that reduce the load on the tendons when they slide against the bone or against each other. The hamstring muscles include the semitendinosus and biceps femoris (which attach to the conjoin tendon on the ischial tuberosity) and semimembranosus. The hamstring muscles bend the knee and extend the hip.
Right gluteal muscles from behind:
A. Bursa trochanterica m. glutei maximi
B. M. gluteus maximus
C. M. biceps femoris (caput longum)
D. M. semitendinosus
E. M. semimembranosus
F. M. adductor magnus
G. M. gracilis
H. M. quadratus femoris
I. Bursa ischiadica m. glutei maximi
Cause of the problem
With repeated strain or impact, the bursa can become ‘inflamed’, produce increased fluid, swell and become painful. The condition is often combined with tendinitis at the ischiatic bone.
Symptoms
Pain when applying pressure (sitting position) on the outside of the ischial tuberosity. The pain is often aggravated by stretching and activating the thigh muscles (bending the knee and stretching the hip against resistance).
Examination
In mild cases with only minimal tenderness, the diagnosis is usually made by clinical examination alone. For more severe pain or lack of progress, a professional examination should be performed to ensure proper diagnosis and treatment.
If there is any doubt about the diagnosis, an ultrasound and possibly an MRI scan can be performed.
Treatment
Treatment primarily includes relief from pain-inducing activity, stretching and graduated rehabilitation within the pain threshold. If rehabilitation is unsuccessful, treatment can be supplemented with anti-inflammatory drugs (NSAIDs) or injection of adrenal cortex hormone into the bursa as part of long-term rehabilitation of an often chronic (long-term) injury, it is essential that the rehabilitation programme extends over several months to reduce the risk of relapse.
Complications
If progress is not smooth, consider whether the diagnosis (Zibis AH, et al. 2018) is correct or if complications have arisen.
In particular, the following should be considered:
