Table 5 Problem based approach: Ischial tuberosity (diagnoses appear in order of frequency in an athletic population)
Define and alignPathologyListen and localisePalpate and recreateAlleviate and investigate
Ischial tuberosityHamstring origin tendonopathySudden pain in buttock/posterior thigh. Walking painful.57Tenderness of muscle belly or tendon from common originMRI57 58
Proximal hamstring tearSudden pain on acceleration or deceleration, localised to hamstring muscle belly. Weakness, stiffnessTenderness, palpable haematoma or defect in muscleUltrasound scan,34 MRI57
Ischial bursitisPain on sitting, worsens on movement. Likely to be co-existent injury with hamstring injuryTenderness of ischial tuberosity37Ultrasound scan38guided local anaesthetic injection34
Ischial tuberosity apophysitis/ avulsion fractureShooting pain following high energy kick or change of direction.Bogginess of ischial tuberosity tenderness to palpation59Plain film60
Stress fracture of pubic ramusGradual onset, change in training loadPain standing on one leg and Hop test,40 associated deep buttock painPlain film, bone scan17 MRI18
  • MRI, magnetic resonance imaging.