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 presented 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 ischial tuberosity. Ischiofemoral impingement test was positive. Type of Probe Used: 5-1 MHz Curvilinear Transducer Unlabeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Unlabeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Labeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Labeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle. The Quadratus Femoris measures approximately 9.1 mm in thickness. The ischiofemoral distance is approximately 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. Unlabeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Unlabeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Labeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle Labeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle. The Quadratus Femoris Muscle measures approximately 12.3 mm in thickness. The ischiofemoral distance is approximately 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. #5 - Video View Video Cine of the right (affected) ischiofemoral space long axis to the quadratus femoris muscle with dynamic assessment of the right ischiofemoral space with hip extension, adduction, and external rotation. Note the abutment of the femur on the ischium with extrusion of the sciatic nerve. #6 - Video View Video Cine of the left (aunffected) ischiofemoral space long axis to the quadratus femoris muscle with dynamic assessment of the right ischiofemoral space with hip extension, adduction, and external rotation. Normal assessment. Interpretation Image Interpretation: A large, amorphous, hyperechoic lesion adjacent to the iischial tuberosity 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 unaffected 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 lies between the lateral ischial tuberosity and lesser trochanter and contains the quadratus femoris muscle. Narrowing of this space can cause posterior buttock pain worsened by hip extension, adduction, or prolonged weight-bearing. Ultrasound may show a narrowed ischiofemoral space, quadratus femoris atrophy or fatty change, proximal hamstring tendinopathy, and sciatic nerve enlargement. Because the space is dynamic and position-dependent, ultrasound measurements should be interpreted with symptoms and MRI when deeper muscle edema or fatty infiltration needs confirmation. References: 1. Wu WT, Chang KV, Mezian K, et al. Ischiofemoral impingement syndrome: clinical and imaging/guidance issues with special focus on ultrasonography. Diagnostics (Basel). 2023;13(1):139. doi:10.3390/diagnostics13010139 2. Finnoff JT, Bond JR, Collins MS, et al. Variability of the ischiofemoral space relative to femur position: an ultrasound study. PM R. 2015;7(9):930-937. doi:10.1016/j.pmrj.2015.03.010 3. Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186-190. doi:10.2214/AJR.08.2090
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Authors, Editors, Case Information

Unlabeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle

Labeled View of the Right (affected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle

Unlabeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle

Labeled View of the Left (unaffected) Ischiofemoral Space Long Axis to the Quadratus Femoris Muscle

#5 - Video

#6 - Video

Interpretation

UPCOMING EVENTS

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