A tale of two sit-bones: The cyclist’s ischial hygroma (Perineal nodular induration)

The ischial hygroma or perineal nodular induration is a relatively rare and cycling specific injury that is often incorrectly diagnosed and managed. We highlight two cases with divergent managements to highlight the spectrum of treatment available to manage this rare condition. We describe the presentation, assessment and management of two cases of pernineal nodular induration. The management (surgical excision vs conservative management with saddle pressure mapping) highlight that there is no single optimal management and a multidisciplinary approach should be applied to treat these injuries successfully. Perineal nodular induration should be investigated appropriately to exclude less benign causes of perineal masses. Both conservative management and surgical excision can be successful. Clinicians should be familiar with assessment and management options for this relatively rare but debilitating condition in competitive cyclists.