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Inferior gluteal pain with sitting, unrelated to ischial bursitis
  1. Chad Mears1,
  2. Renuka Rudra2,
  3. Alex John1 and
  4. Weibin Shi1
  1. 1Physical Medicine and Rehabilitation, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Weibin Shi; wshi{at}


A 64-year-old woman presented to an academic medical centre with postoperative left ischial pain following a left total hip replacement. Her pain was exacerbated by sitting down and with forward flexion of the spine, and the pain radiated from the left ischial tuberosity to the left perineum, groin and medial thigh. An ischial bursa injection was performed, but only resulted in 1 day of excellent pain relief. A diagnosis of inferior cluneal neuralgia was then made. Subsequent inferior cluneal nerve radiofrequency ablation was performed, and provided sustained 50% relief in pain. The patient had a concomitant sensation of ‘ball like’ pressure at her rectum which was determined to be due to levator ani syndrome. She was prescribed pelvic floor physical therapy and botulinum toxin injection, which resulted in further notable improvement of her symptoms.

  • pain
  • physiotherapy (rehabilitation)
  • musculoskeletal syndromes

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  • Contributors CM and AJ: resident physicians, collected clinical data and drafted the manuscript; RR: resident physician, critically revised the manuscript; WS: treating attending physician, analysed clinical data, conceptualised the case report and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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