Ischial Bursitis Injection

Ischial Bursitis Injection with corticosteroid is indicated in acute or chronic ischial bursitis, which caused by friction overuse, such as prolonged cycling; trauma, such as a fall onto buttock.

Ischial bursitis is characterized by pain in buttock over tuberosity; painful resisted extension, passive straight leg raise.

Equipment Needed

• Syringe: 2 ml
• Needle: Green, 21 gauge 
• Kenalog 40: 20 mg
• Lidocaine:  1.5 ml, 2%
• Total volume: 2 ml

Related Anatomy

The hamstring tendons have a common origin arising from the ischial tuberosity and are approximately three fingers wide at this point. The ischial bursa lies between the gluteus maximus and the bone of the ischial tuberosity, just deep to the tendon.

See Also: Hip Muscles Anatomy

Ischial Bursitis Injection Technique

• Patient lies on unaffected side, with lower leg straight and upper leg flexed,
• Identify ischial tuberosity and mark tendon origin lying immediately distal,
• Insert needle into midpoint of tendon, and angle up towards tuberosity to touch bone,
• Pepper solution into teno-osseous junction of tendon, or inject as a bolus into bursa.

Avoid precipitating activities such as continually sitting on hard surfaces or prolonged running until pain eases, and then a graduated stretching and strengthening programme can be started.

Notes

Bursitis can occur together at this site, in which case a larger volume is drawn up and both lesions are infiltrated. It may be difficult to differentiate between the two lesions, but if there is extreme tenderness at the tuberosity and history of a fall onto buttocks, bursitis is suspected. Occasionally, haemorrhagic bursitis can occur as a result of a hard fall. Aspiration of the blood is then performed before infiltration.

Ultrasound-guided ischial bursa injections are technically feasible. Flexing the hip to 90° increases the distance between the ischial tuberosity and the sciatic nerve in asymptomatic volunteers, thus potentially resulting in a safer needle trajectory when ischial bursa injections are clinically indicated. Further investigation in clinical settings is warranted to validate these findings.

References & More

1. Wisniewski SJ, Hurdle M, Erickson JM, Finnoff JT, Smith J. Ultrasound-guided ischial bursa injection: technique and positioning considerations. PM R. 2014 Jan;6(1):56-60. doi: 10.1016/j.pmrj.2013.08.603. Epub 2013 Aug 31. PMID: 24001885.
2. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition.
3. Guided Injections of the Hip – Link