Effects of Inflammatory Disease on Clinical Progression and Treatment of Ischiogluteal Bursitis: A Retrospective Observational Study

Abstract

Introduction: The symptoms of Ischiogluteal Bursitis (IGB) are often nonspecific and atypical, and its diagnosis is more challenging. Moreover, it is difficult to predict cases of chronic progression or poor treatment response. Therefore, the aim of this study was to investigate the clinical course of IGB patients and identify factors that are predictive of failure of conservative treatment.

Materials and methods: Our study consisted of IGB patients diagnosed between 2010 March and 2016 December who had been followed-up for at least one year. Structured questionnaires and medical records were reviewed to analyse demographic characteristics, lifestyle patterns, blood tests, and imaging studies. We categorized the cases into two groups based on the response to conservative treatment and the need for surgical intervention.

Results: The most common initial chief symptoms were buttock pains in 24 patients (37.5%). Physical examinations showed the tenderness of ischial tuberosity area in 59 (92.2%) patients, but no specific findings were confirmed in 5 patients (7.8%). 51 patients (79.7%) responded well to the conservative management, 11 patients (17.2%) needed injection, and 2 patients (3.1%) had surgical treatment performed due to continuous recurrence. There was no difference in demographic and blood lab data between the two groups. However, the incidence of inflammatory diseases (response group: 10.3% vs non-response group: 66.7%, p=0.004) was significantly different between the two groups.

Conclusion: The diagnosis of IGB can be missed due to variations in clinical symptoms, and cautions should be exercised in patients with inflammatory diseases as conservative treatment is less effective in them, leading to chronic progression of IGB.

Keywords: clinical course; inflammatory disease; ischiogluteal bursitis; risk factor; treatment responsiveness.

Fig. 1:

Patient enrollment flow chart. This study involved ischiogluteal bursitis in 64 patients.

Fig. 2:

The image of ultra-sonography in a 76-year female shows hypoechoic lesion (arrow head) with acoustic enhancement represents the ischiogluteal bursitis.

Fig. 3:

The axial image of the pelvis magnetic resonance imaging in a 79-year old male. (a) A cystic lesion (arrow) showing low signal intensity was observed in T1-weighted view. (b) It was observed that the same lesion (arrow) showed high signal intensity in T2-weighted view. (c) In the contrast-enhanced T1-weighted view, it is observed that the wall of the cystic lesion (arrow) is enhanced.