Ischiofemoral impingement
What is it:
– Narrowing of the space between the lesser trochanter of the femur and ischium of the pelvis
Presentation:
– Pain often reported in the lower buttock region, groin/inner thigh +/- snapping/clunking sensation
– Close involvement of quadratus femoris muscle, proximal hamstring tendon and psoas tendon
– Combination of hip extension/adduction/ER can be provocative with closing in of the lesser trochanter of the femur towards the ischium OR stretching of quadratus femoris (opposite of closing down pattern)
– Pain often reported in the lower buttock region, groin/inner thigh +/- snapping/clunking sensation
– Close involvement of quadratus femoris muscle, proximal hamstring tendon and psoas tendon
– Combination of hip extension/adduction/ER can be provocative with closing in of the lesser trochanter of the femur towards the ischium OR stretching of quadratus femoris (opposite of closing down pattern)
– Long-stride walking can be provocative (again in an ext/add/ER position – lagging leg)
– Clinically subjective reports are load dependent
– Can mimic presentations similar to Lx referral, “sciatica”, proximal hamstrings, groin etc
Imaging:
– MRI findings may show quadratus femoris oedema, narrowing of the ischiofemoral space with coxa valga (although this may also represent standing posture at the time of imaging, may not be an accurate finding more so just incidental)
– MRI findings may show quadratus femoris oedema, narrowing of the ischiofemoral space with coxa valga (although this may also represent standing posture at the time of imaging, may not be an accurate finding more so just incidental)
– Noted bilat ischiofemoral narrowing doesn’t seem to correlate with bilat symptoms
Risk factors:
– Risk factors may be gender (more females reported ?greater Q-angle), following surgery (e.g. THR, femoral osteotomies), or other hip joint pathologies (OA, cam lesions, previous DDH or Perthes), functional patterns (reduced hip abd moments), tendon pathologies (hamstring enthesopathies, psoas etc)
Management:
– Medical Mx
– Surgical resection (esp if cause is tumour, osteochondroma)– CSI to quadratus femoris if indicated