ischiofemorales Impingement

Ischiofemorales
Impingement rechts bei einer 67-jährigen in der MRT (PDW SPAIR ax). Deutliches Ödem im M. quadratus femoris und den angrenzenden Muskeln.
Wikipedia • CC BY-SA 3.0
Ischiofemoral
impingement, an atypical cause of hip pain. MR-image through the right lesser trochanter (LT) and ischium (I) shows the ischiofemoral space (full line), quadratus femoris space (dotted line), quadratus femoris muscle (asterisks), and a bursalike formation (curved arrow) against the tendon.
www.eurorad.org • CC by-nc-sa-4.0
Ischiofemoral
impingement, an atypical cause of hip pain. MR image of both hips shows also narrowing of the ischiofemoral space on the left (double arrow) and intratendinous signal changes and thickening of the hamstring tendons on the right (arrow).
www.eurorad.org • CC by-nc-sa-4.0
Ischiofemoral
impingement, an atypical cause of hip pain. Coronal MR image of the right hip demonstrates the narrowed ischiofemoral space (double arrow) between the lesser trochanter (LT) and ischium (I).
www.eurorad.org • CC by-nc-sa-4.0
Characteristics
of hip impingement syndrome in patients with multiple hereditary exostoses. Illustration of the hip joint explaining why ischio-femoral impingement (IFI) symptoms are more common than femoro-acetabular (FAI) symptoms in hips with multiple hereditary (MHE). a The normal hip joint morphology without MHE. The hatched part in the figure shows the exostoses that can occur in the femoral head and neck area. In this circumstance, the incidence of both FAI and IFI is likely to increase. b MHE hip patients with the characteristic deformities. Though hatched part of the exostoses may increase the possibility of the impingement, coxa valga deformity reduces the possibility of impingement between the femoral head and acetabulum by increasing the working distance. On the contrary, coxa valga deformity acts as a risk factor for the development of IFI reducing the distance between the exostoses and the ischium
bmcmusculoskeletdisord.biomedcentral.com • CC-by-4.0
Characteristics
of hip impingement syndrome in patients with multiple hereditary exostoses. Measurement of minimum ischio-femoral distance to evaluate ischio-femoral impingement in a computed-tomographic study. The minimum ischio-femoral distance is determined by the nearest distance between the exostoses and ischium around the lesser trochanter area were measured at axial CT plane
bmcmusculoskeletdisord.biomedcentral.com • CC-by-4.0
Ischiofemoral
impingement • Femoral osteochondroma causing ischiofemoral impingement - Ganzer Fall bei Radiopaedia
Marghany B, Femoral osteochondroma causing ischiofemoral impingement. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-88165 • CC by-nc-sa 3.0 (modified)
Heterotopic
ossification • Ischial tuberosity avulsion with heterotopic bone formation - Ganzer Fall bei Radiopaedia
Bickle, I. Ischial tuberosity avulsion with heterotopic bone formation. Case study, Radiopaedia.org. (accessed on 06 Nov 2022) https://doi.org/10.53347/rID-87060 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Ischiofemoral impingement refers to the impingement of soft tissues between the ischial tuberosity and lesser trochanter of the femur.

Clinical presentation

Ischiofemoral impingement is a rare cause of buttock pain, groin pain, or a snapping hip .

Epidemiology

Females are more affected than males. Ischiofemoral narrowing may be bilateral but symptoms may only be unilateral .

Pathology

Narrowing of ischiofemoral space and quadratus femoris space or the distance between the ischial tuberosity and lesser trochanter of the femur predisposes to symptomatic ischiofemoral impingement, primarily affecting the quadratus femoris muscle manifesting with muscle belly edema in the acute setting and fatty degeneration in chronic cases. It can also lead to tears of the common hamstring tendon.

Etiology

There are numerous causes for narrowing of the ischiofemoral and quadratus femoris space including :

Radiographic features

Plain radiograph

A recent study suggested ischiofemoral impingement is likely in patients with chronic pelvic pain if the ischiofemoral space is <2 cm or <1.9 cm on supine and standing pelvic x-rays, respectively. It warrants further investigation by pelvic MRI .

MRI

The main finding in the acute case is muscle edema of the quadratus femoris muscle, in some cases with concomitant adventitious bursitis .

In chronic situations of impingement, there will be fatty infiltration and atrophy of the quadratus femoris muscle and sometimes tears of the hamstring musculature at their common insertion site .

In addition, the ischiofemoral and quadratus femoris spaces can be measured, they are, however difficult to standardize due to leg positioning :

  • T1
    • ischiofemoral space is measured on an axial T1 sequence
      • shortest distance between medial cortex lesser trochanter and lateral cortex ischial tuberosity
      • cut-off: ≤15 mm (sensitivity 77%, specificity 81%, accuracy 74%) 
    • quadratus femoris space is measured on an axial T1 sequence
      • smallest distance for the passage of quadratus femoris between the posteromedial iliopsoas tendon or ischial tuberosity and the superolateral hamstring tendons
      • cut-off: ≤10 mm (sensitivity 79%, specificity 74%, accuracy 77%)
    • fatty atrophy of quadratus femoris may be present
  • STIR/T2 FS
    • ​quadratus femoris muscle belly edema and/or tears
    • muscle belly edema may extend to the hamstrings and/or iliopsoas muscles

History and etymology

Ischiofemoral impingement was first described as a cause for hip pain by K A Johnson in 1977 .

Siehe auch:
Assoziationen und Differentialdiagnosen zu ischiofemorales Impingement:
Impingement
 
Wikipedia • CC BY-SA 3.0
Umstellungsosteotomie
Femur
Wikipedia • Public domain
Impingement
Syndrome bei Patienten mit multiplen kartilaginären Exostosen
bmcmusculoskeletdisord.biomedcentral.com • CC-by-4.0