So you have hip pain… Could it be a type of impingement you may not know about?

Ischiofemoral Impingement can be an under-recognized cause hip, buttock, or inner thigh pain. It is cause by a narrowing of the space between the Ischium (the lower, lateral pelvic bone) and the Lesser Trochanter of the Femur bone. Pain can arise from this as the soft tissues of the body are pinched between these two boney prominences. Using magnetic resonance imaging (MRI), it has been demonstrated that the muscle being compressed in this area is the Quadratus Femoris muscle. This muscle functions in the body to help externally rotate the leg, which causes your foot to turn outwards. When the Quadratus Femoris is compressed it can cause edema (swelling) in the muscle, and may over time cause the muscle to atrophy (become smaller).

Ischiofemoral Impingement Syndrome tends to affect middle-age to elderly females and causes them to have hip and/or groin pain. It can also cause there to be pain in the buttock and in the lower back, which may mimic other medical conditions. A state of chronic lower back pain can commonly be present and may prompt a medical provider to obtain a MRI. Other conditions it may mimic are a hamstring or gluteal tendinopathy, lumbar radiculopathy, or femoroacetabular impingement.

Risk factors for Ischiofemoral Impingement Syndrome are: female gender, a history of surgery, fracture or arthrosis of the femur; a repetitive positional strain, a congenital narrowing of the space, or coxa valga. On physical exam most patients will experience discomfort during range of motion of the hip. To help determine the cause, a physician may attempt to reproduce the pain the patient experiences outside the office. Symptoms may be reproduced if the physician flexes and internally rotates (turns in) the hip, or with extension, external rotation, and adduction (bring the whole leg towards the middle of the body).

This condition is diagnosed by a physician’s clinical suspicion of the syndrome and a MRI may confirm its presence. Regular x-rays are typically normal, except they may be able to demonstrate the lesser trochanter and the ischium being abnormally close. A MRI is used to detect the size of the Quadratus Femoris and the space for this muscle to move it. It will also look for signs of edema, as the more severe the impingement is the more the edema will be noticeable.

The mainstay of treatment for Ischiofemoral Impingement Syndrome is conservative therapy. This starts with allowing the body to rest by having activity restriction and by starting non-steroidal anti-inflammatory medications (NSAIDS, like ibuprofen). It is then important to begin a physical therapy program in attempt to strengthen the gluteal muscles in the buttock and have the patient be able to better control their pelvis and lower extremity. If this therapy fails then an ultrasound or computed tomography (CT)- guided steroid injection can be attempted to provide relief of pain. If all other therapies fail then a surgical approach is the last option. A surgeon can perform an operation to remove the lesser trochanter of the femur to relieve the compression of the Quadratus Femoris.

If you have questions or concerns about hip or back pain, or general overall health, please schedule an appointment with Dr. David Carfagno to discuss your concerns.

 

Chase King, MS-IV

David Carfagno, D.O., C.A.Q.S.M.

 

References:

Backer, Matthew W., Kenneth S. Lee, Donna G. Blankenbaker, Richard Kijowski, and James S. Keene. "Correlation of Ultrasound-Guided Corticosteroid Injection of the Quadratus Femoris With MRI Findings of Ischiofemoral Impingement." <i>American Journal of Roentgenology</i> 203.3 (2014): 589-93. Web.

Ghodduci, Moshirian, et al. "Ischiofemoral Impingement: An Unusual Cause of Hip Pain in Women - a Case Series." Universitair Ziekenhuis Brussel, n.d. Web.

Jo, S., and J. M. O'donnell. "Endoscopic Lesser Trochanter Resection for Treatment of Ischiofemoral Impingement." <i>Journal of Hip Preservation Surgery</i> 2.2 (2015): 184-89. Web.

Kerr, Roger M., MD. "Ischiofemoral Impingement Syndrome." <i>RadSource</i>. N.p., n.d. Web.

Opstedal, Laura, DPT. "Ischiofemoral Impingement: Another Source of Hip Pain." <i>Laura Opstedal</i>. N.p., 23 Oct. 2015. Web.

 

Image 1 Credit: http://m1.wyanokecdn.com/32e407b774d199512ba53cd2ffddaa41.jpg

Image 2 Credit: http://www.yogaartandscience.com/index_files/bones%20of%20hip%20and%20pe...

 

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