Can You Fix Santa Before Christmas!?

PM&R Case   •   December 2017

T’was a few days before Christmas and Santa Claus (and the world) desperately need your help! He presents to your clinic hoping you can save him.

A 1700-year-old male presents to your clinic with a 3 month history of right buttock pain without inciting event. He describes a 9/10 right buttock pain that is characterized as stabbing and occasionally radiates in the right lower leg. Pain is worse when sitting in his sleigh or at the mall. He notes that children sit on his right leg when taking pictures. He has an elf therapist on staff, but he has been too busy to go to sessions this time of the year. He has not had any imaging or further workup. He does not stretch or exercise.

On physical exam, his BMI is 50. He is in no acute distress, but leans towards the left in the chair. His general exam is benign.

There are no gross abnormalities on inspection of his back or left buttock. There is severe tenderness to palpation of the right ischial tuberosity, no tenderness elsewhere. ROM of the lumbar spine and hips is normal. There are no sensory deficits or abnormal reflexes. Strength is normal. Straight leg raise and FABER are negative.

Because of your physical exam findings you defer imaging or lab work.

What is your diagnosis?

Ischiogluteal Bursitis

Because Santa sits for many hours at a time in his sleigh and at the mall, he developed ischiogluteal bursitis. His hamstrings are also 1700 years old and he rarely stretches.

Ischiogluteal bursitis is the inflammation of the bursa sac that lies between the ischial tuberosity (sitting bone) and the hamstring tendons.

In this case, we (yes the PM&R QBank Doctors) treated Santa with a corticosteroid injection and instructions for his elf therapist to focus specifically on hamstring flexibility. We also recommended that Santa change his sleigh cushion and take frequent standing breaks.

Thanks for your help in solving this case and saving Christmas!

Santa did sign a HIPAA release form, so you are free to discuss this case with your colleagues :)

Review Question

Can you name all of the hamstring tendons that attached at the ischial tuberosity?

Answer

The biceps femoris, semitendinosus and semimembranosus all come together to form the common hamstring tendon that attaches to the ischial tuberosity.