Findings: MRI of
both hips shows severe edema and partial tear of left quadratus femoris and
mild edema on right. There is bursalike formation near deformed left quadratus
femoris muscle. Ischiofemoral space (smallest distance between lateral cortex
of ischial tuberosity and medial cortex of lesser trochanter) and quadratus
femoris space (smallest distance between superolateral surface of hamstring
tendons and posteromedial surface of iliopsoas tendon or lesser trochanter) are
narrow.
Diagnosis: ischiofemoral
impingement syndrome
Discussion:
Ischiofemoral
impingement is defined as the entrapment of the quadratus femoris muscle
between the lesser trochanter of the femur and the ischial tuberosity.
Quadratus femoris muscle arises from the upper part of the external border of
the ischial tuberosity. It is inserted into the minor tubercle of the trochanteric
crest of the femur. Abnormalities of the quadratus femoris may cause hip,
buttock, and groin pain that can radiate distally from the posterior thigh.
According to the
recent researches, ischiofemoral and quadratus femoris spaces are narrower in
patients with ischiofemoral impingement syndrome than those of healthy
subjects. The ischiofemoral space is defined as the smallest distance between
the lateral cortex of the ischial tuberosity and medial cortex of lesser
trochanter. The quadratus femoris space is defeined as the smallest space for
passage of the quadratus femoris muscle delimited by the superolateral surface
of the hamstring tendons and the posteromedial surface of the iliopsoas tendon
or lesser trochanter.
Most of the
affected patients in recently published reports with quadratus femoris
muscle abnormality were female. There
might be a potential correlation between the ischiofemoral space narrowing and
anatomy of female pelvis, such as prominence of the lesser trochanter in the
female pelvis. The increase in the angle between the long axis of femoral neck
and the long axis of the femoral shaft is one of the factor which may may
result quadratus femoris muscle edema and ischiofemoral impingement syndrome.
The diagnosis of ischiofemoral impingement
syndrome depends on both clinical and imaging evidence. There is no specific
test to diagnose ischiofemoral impingement syndrome. However, MRI has been used
in diagnosis of impingement syndromes, which has led to improved treatment
protocols.
References:
1. 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 Jul;193(1):186-90.
2. Ali AM,
Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a
snapping hip due to ischiofemoral impingement. Skeletal Radiol. 2011 May;40(5):653-6.
3.Tosun O, Algin
O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement:
evaluation with new MRI parameters and assessment of their reliability.
Skeletal Radiol. 2012 May;41(5):575-87.
