Bursitis is an inflammation or degeneration of the sac-like structures that protect the soft tissues from underlying bony prominences. Bursitis may result from a local insult or be a manifestation of a systemic disease. Examples of the latter include rheumatoid arthritis, tophaceous gout, and sepsis. Adjacent tenosynovitis and calcium apatite deposition disease commonly coexist.
More than 140 bursae have been described in the human body. The clinically important bursae are the trochanteric, subdeltoid, ischiogluteal, pes anserine, iliopsoas, retrocalcaneal and olecranon bursae.
Ischial bursa injection can be of diagnostic benefit and therapeutic value in patients with chronic buttock pain secondary to ischial bursitis. However it is important to note that in some cases injection treatment may not provide the desired results or the pain relief may not be sustained. At Pain Spa Dr Krishna is very experienced in interventional treatments. Dr Krishna always performs ischial bursa injections under ultrasound guidance for greater accuracy and improved safety. Ultrasound gives the added advantage of targeting the surrounding tendons and muscles, which can be contributory to pain.
At Pain Spa Dr Krishna is very experienced in interventional treatments. Dr Krishna always performs ischial bursa injections under ultrasound guidance for greater accuracy and improved safety. Ultrasound gives the added advantage of targeting the surrounding tendons and muscles, which can be contributory to pain.
Ischiogluteal bursitis is clinically characterized by pain over the centre of the buttock and along the hamstring muscles of the leg. Pain is exacerbated by sitting down and may be relieved to some extent on standing. Differential diagnosis include disc herniation in the lumbar spine, piriformis syndrome and radiculopathy.
Imaging studies are helpful in evaluating the nature and extent of the bursa and in differentiating the mass from ganglion cyst, schwannoma in the sciatic nerve, and other benign and malignant neoplasms with cystic changes.
Injection of local anaesthetic and steroids can be effective in management of nonseptic bursitis. Ischial bursa injections are ideally performed under ultrasound guidance. Ultrasound imaging enables visualization of individual tendons as they emerge from the ischial tuberosity.
Diagnostic local anesthetic injections into the ischial bursa can potentially be helpful when the diagnosis is uncertain.
Corticosteroids are often injected into the bursa when other conservative measures are unsuccessful.
Injections are generally avoided in patients with systemic infection or skin infection over puncture site, bleeding disorders or coagulopathy, allergy to local anaesthetics or any of the medications to be administered.
The procedure is usually done on an outpatient basis. The procedure is performed under ultrasound guidance to ensure accuracy of needle placement. Patients need to be aware that the outcome of the procedure is variable and they may not receive the desired benefits. Similarly, they must be aware of the transient nature of the therapeutic benefits and that they may need repeated injections.
Generally a mixture of local anaesthetic and steroid is injected. The local anaesthetic agent within the injectate may act on the nociceptive fibres , whereas corticosteroids may reduce inflammation. The anaesthetic is probably responsible for immediate pain relief, whereas steroids are believed to be responsible for pain relief 2–6 days after their administration.
Complications are rare, particularly if the injections are performed using a precise needle-positioning technique. Possible complications include bruising, infection, hematoma, nerve injury and reaction to the injectates. Infection can be avoided with appropriate aseptic precautions. Severe allergic reactions to local anaesthetics are uncommon. Steroid injections may produce local reactions, occurring most often immediately after injection. These local reactions last for 24 to 48 hours, and are relieved by application of ice packs. Post-procedural pain flare-up may occasionally occur, and may be treated with pain killers. Neurological complications (injury to sciatic nerve) including paraesthesias and numbness have been described but are extremely rare.
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