Ischiofemoral Impingement

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Ischiofemoral Impingement

Authors, Editors, Case Information Author: Altamash Raja, DO, CSCS Affiliation: Rowan-Virtua School of Osteopathic Medicine Co Author(s): Jaime Dougherty, DO Editor: Raul Rosario-Concepcion, MD Clinical Vignette: A 26-year-old female with right posterior hip pain for over a decade. Pain was exacerbated by exercise and sitting. Physical examination was positive for tenderness along the right posterior hip and the ischial tuberosity (IT). Ischiofemoral impingement (IFI) test was positive. Type of Probe Used: 5-1 MHz Curvilinear Transducer #1 - Video View Video Dynamic assessment of the right ischiofemoral space. Note the abutment of the femur on the ischium with extrusion of the sciatic nerve. #2 - Video View Video Dynamic assessment of the left ischiofemoral space. Left Posterior Hip Leftischiofemoral space with the transducer in transverse plane, long axis to the quadratus femoris muscle which is 12.3 mm in thickness. The ischiofemoral distance is 20.6 mm. The blue arrow indicates the sciatic nerve. The yellow dashed line with arrows indicates the ischiofemoral space. GMA = Gluteus maximus muscle; QF = Quadratus femoris muscle; IT = Ischial tuberosity; LT = Lesser trochanter. Right Posterior Hip Right ischiofemoral space with the transducer in transverse plane, long axis to the quadratus femoris muscle which is 9.1 mm in thickness. The ischiofemoral distance is 15.5 mm. The blue arrow indicates the sciatic nerve. The yellow dashed line with arrows indicates the ischiofemoral space. GMA = Gluteus maximus muscle; QF = Quadratus femoris muscle; IT* = Ischial tuberosity fragment; LT = Lesser trochanter. Left Posterior Hip Left ischiofemoral space with the transducer in transverse plane, long axis to the quadratus femoris muscle. Right Posterior Hip Right ischiofemoral space with the transducer in transverse plane, long axis to the quadratus femoris muscle Interpretation Image Interpretation: A large, amorphous, hyperechoic lesion adjacent to the IT is noted. Additional findings are suggestive of proximal hamstring tendinosis and a markedly atrophied quadratus femoris muscle with fatty infiltration. The overlying sciatic nerve is enlarged. With the femur in neutral, the ischiofemoral space measures 15.5 mm and the quadratus femoris is 9.1 mm in thickness. The contralateral ischiofemoral space is 20.6 mm and quadratus femoris muscle is 12.3 mm in thickness. Dynamic assessment under ultrasound reproduced patient symptoms, including shooting pain along the posterior thigh as the sciatic nerve displaces out of the ischiofemoral space. These findings are suggestive of ischiofemoral impingement. Teaching Pearl: The ischiofemoral space is anatomically adjacent to the ischial tuberosity and contains the quadratus femoris muscle, bordered by the lateral cortex of the ischial tuberosity and medial cortex of the lesser trochanter of the femur. With narrowing of the IFS, patients experience posterior buttock pain that worsens with hip extension, adduction, and prolonged weight-bearing activities. Considering the dynamic nature of the impingement, the literature is somewhat unclear with respect to absolute cutoff values for ischiofemoral impingement. However, femur position plays a critical role in the ischiofemoral distance, with the largest distance being in hip abduction and internal rotation. Other notable findings on imaging that can help solidify the diagnosis are morphological changes of the quadratus femoris muscle and the overlying sciatic nerve as well as dynamic assessment of the ischiofemoral distance.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

#1 - Video

#2 - Video

Left Posterior Hip

Right Posterior Hip

Left Posterior Hip

Right Posterior Hip

Interpretation

UPCOMING EVENTS

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