Ischiofemoral impingement

Abstract

Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised impingement-type condition around the hip - ischiofemoral impingement. This is caused by abnormal contact between the lesser trochanter of the femur and the ischium, and presents as atypical groin and/or posterior buttock pain. The symptoms are gradual in onset and may be similar to those of iliopsoas tendonitis, hamstring injury or bursitis. The presence of ischiofemoral impingement may be indicated by pain caused by a combination of hip extension, adduction and external rotation. Magnetic resonance imaging demonstrates inflammation and oedema in the ischiofemoral space and quadratus femoris, and is distinct from an acute tear. To date this has only appeared in the specialist orthopaedic literature as a problem that has developed after total hip replacement, not in the unreplaced joint.

Ischio femoral impingement in an 11-year-old girl

“…No definitive treatment has been recommended, other than excision of the lesser trochanter (10). The optimal treatment strategy of this syndrome remains obscure.…”

İskiofemoral sıkışma sendromu

“…Plain radiographs are typically normal, they may demonstrate decreased distance between the osseous prominences of the lesser trochanter and ischium , as well as cystic changes and sclerosis within the lesser trochanter or ischial tuberosity 4,6,17 . Ultrasound studies of the hip and surrounding structures have not so far proved useful in the diagnosis of either ischiofemoral impingement or an acute tear in quadratus femoris, however can be used to rule out a snapping psoas tendon 18,19 .…”

Clinical significance of signal changes in the quadratus femoris muscle on MR

“…This had to be treated by surgical decompression due to persistent sciatica (14). Associated morbidity would be too high if resection of the lesser trochanter was to be used as the routine treatment resulting in weakness of hip flexion (22). Treatment with corticosteroid injection in or around the hip, non-steroidal anti-inflammatory drugs, transcutaneous neurostimulation, ultrasound therapy, and proper stretching technique have been shown to be effective with return to normal activity in the majority of reports describing treatment (2-4, 6, 8, 13).…”