LAUSR

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Weaver’s bottom, popularly known as ischial bursitis, is a highly unusual entity affecting adults and older populations. Ischial bursitis is an inflammation of the ischial bursa and fluid collection and associated changes in the hamstring muscle complex (HMC). The ischial bursa lies near the ischial tuberosity, protected by the gluteus maximus muscle during extension; however, this protective covering is lost during sitting position and is sandwiched between the ischial tuberosity and external surface. The ischial tuberosity is an important landmark that provides attachment to the HMC. The HMC comprises of biceps femoris, semitendinosus and semimembranosus. The HMC is the active extensor of the pelvis and flexor of the knee, making it highly prone to sprain and injuries as it involves various complex movements across the hip and knee joints. Diagnosis in early stage and prompt treatment can prevent further damage and tears of HMC. The diagnosis of ischial bursitis is often missed due to its rarity and nonspecific symptoms. The symptoms include pain in the buttock, posterior thigh, perineum, difficulty getting up and local swelling. The diagnosis is usually made clinically; however, ultrasound or MRI is advisable for confirmation. The MRI is the ideal imaging modality to confirm the diagnosis and to exclude the differentials. The MRI scan typically shows fluidfilled distended bursa with additional abnormalities in the HMC. The treatment for this entity includes analgesics, cold therapy, rest, fractional massage and therapeutic stretch exercises. A 55yearold woman presented with pain in bilateral gluteal regions for the last 6 months. Pain aggravated over the previous 2 months. She complained of difficulty in changing position from sitting to standing and vice versa. Vital parameters were normal at the time of presentation. On local examination, there was tenderness over bilateral gluteal regions. The active flexion movements at the knee were restricted. She was advised for radiographs of bilateral hip and sacroiliac joints, which were unremarkable. For further evaluation, she underwent MRI of bilateral hip joints, including the pelvis. The MRI revealed abnormal increased fluid intensity signals in ischial bursae on both sides and loss of normal hypointense signals in the tendons of hamstring muscles (figure 1A,B). The tendons had wavy contours with increased fluid signal intensities representing chronic microtears (figures 2A, B and 3). The final diagnosis of ischial