Ischiofemoral Impingement Syndrome Secondary to Arteriovenous Malformation of the Quadratus Femoris

Background: To explore the value of MRI upon diagnosis of ischiofemoral impingement syndrome (IFI) and to recognise deformation or oedema of the quadratus femoris muscle. MRI applied to measure the ischial femoral space (IFS), the average width of quadratus femoral space (QFS), and the ischial intertuberal diameter. Methods: A retrospective analysis was carried out of 213 hip joints MRI images of 58 cases diagnosed with IFI and 61 cases of normal subjects. IFS, QFS and ischial intertuberal diameter were measured by axial T1WI sequence. The morphological and signal changes of the quadratus femoris muscle were observed through proton density weighted image fat suppression sequence (PDWI-FS). Results: The widths of IFS and QFS in the normal group were larger than those in the case group, while the ischial intertuberal diameter was significantly smaller ( p < 0.05). Pearson correlation analysis revealed that there was a positive correlation ( r = 0.824) between IFS and QFS in all hip joints and a negative correlation between the ischial intertuberal diameter and the widths of IFS and QFS ( r = −0.213, −0.222, p < 0.05) respectively. As the grade of oedema in quadratus femoris muscle increased, the corresponding IFS gradually decreased. The corresponding IFS width of grade 0 oedema of the quadratus femoris muscle oedema was significantly higher than that of grade 1, grade 2 and grade 3. The receiver operating characteristic curve (ROC) of the subjects was applied to determine the diagnostic boundary value of the IFS and QFS in IFI patients, which was 1.98 cm and 1.05 cm respectively. The area under the curve (AUC) was 0.948 and 0.953 respectively. Conclusions: MRI examination could provide a reliable basis for the diagnosis of ischiofemoral impingement syndrome. The narrowing of IFS and QFS with deformation and oedema in the quadratus femoris muscle may be the features of manifestation of IFI.

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Ischiofemoral Impingement Syndrome: An Entity With Hip Pain and Abnormalities of the Quadratus Femoris Muscle

American Journal of Roentgenology ◽

10.2214/ajr.08.2090 ◽

2009 ◽

Vol 193 (1) ◽

pp. 186-190 ◽

Cited By ~ 177

Author(s):

Martin Torriani ◽

Silvio C. L. Souto ◽

Bijoy J. Thomas ◽

Hugue Ouellette ◽

Miriam A. Bredella

Keyword(s):

Hip Pain ◽

Impingement Syndrome ◽

Femoris Muscle ◽

Ischiofemoral Impingement ◽

Quadratus Femoris

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Ischiofemoral Impingement Syndrome: Outcomes of Endoscopic Resection of the Lesser Trochanter

Clinics in Orthopedic Surgery ◽

10.4055/cios.2017.9.4.529 ◽

2017 ◽

Vol 9 (4) ◽

pp. 529 ◽

Cited By ~ 5

Author(s):

Alejandro Hernandez ◽

Sleiman Haddad ◽

Jorge H. Nuñez ◽

Albert Gargallo-Margarit ◽

Andrea Sallent ◽

...

Keyword(s):

Endoscopic Resection ◽

Impingement Syndrome ◽

Lesser Trochanter ◽

Ischiofemoral Impingement

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Ischiofemoral Impingement Syndrome

Annals of Rehabilitation Medicine ◽

10.5535/arm.2013.37.1.143 ◽

2013 ◽

Vol 37 (1) ◽

pp. 143 ◽

Cited By ~ 35

Author(s):

Soyoung Lee ◽

Inhwan Kim ◽

Sung Moon Lee ◽

Jieun Lee

Keyword(s):

Impingement Syndrome ◽

Ischiofemoral Impingement

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Quadratus Femoris Partial Tear Secondary to Occult Ischiofemoral Impingement

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i09.2392 ◽

2021 ◽

Vol 11 (9) ◽

Author(s):

Kyriakos A. Papavasiliou ◽

Dimitrios Stamiris ◽

Stavros Stamiris ◽

Antonia Bintoudi ◽

Eleftherios Tsiridis

Keyword(s):

Pathological Condition ◽

Hip Pain ◽

Diagnostic Challenge ◽

Mri Scan ◽

Wide Range ◽

Uncommon Condition ◽

The Right ◽

Increased Activity ◽

Ischiofemoral Impingement ◽

Quadratus Femoris

Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide range of causes must be considered in the deferential diagnosis. Ischiofemoral impingement (IFI) is a pathological condition defined by hip pain associated with narrowing of the ischiofemoral (IF) space. We report the case of an adolescent patient with non-traumatic quadratus femoris (QF) tear secondary to an occult IFI syndrome. To the best of our knowledge, this is the first such case reported in the literature. Case Report: A 15-year-old girl reported persisting hip pain for a month following increased physical activity. The symptoms had started a couple of days following a weekend of increased activity due to her participating in a dancing contest. Physical examination and imaging studies (standard anterior pelvis radiograph and MRI-scan) failed to reveal any pathology apart from an area of diffused edema in the IF space. Standard hematology and biochemistry laboratory tests were all within normal range. Conservative treatment for 6 months with rest and modification of physical activities failed. A new MRI scan showed partial edema resolution and marked reduction in the IF and QF spaces (12 mm and 8 mm, respectively), thus suggesting IFI, which, in turn, led to a partial rupture of the QF. The patient underwent a local infiltration of the QF with betamethasone sodium phosphate and betamethasone acetate (6+6 mg/2 ml) under CT guidance, which led to the complete resolution of all her symptoms. She remains symptoms free for 24 months. Conclusion: IFI is a rather uncommon condition in the developing skeleton. As in adults, in adolescents as well, MRI is the study of choice in cases of IFI, since it shows QF pathology and allows measurement of the IF and QF spaces, assisting physicians in establishing the right diagnosis. However, the coexistence of a QF hematoma and/or edema, may temper with the initial MRI measurements and render the diagnosis of the primary condition rat

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ISCHIOFEMORAL IMPINGEMENT IN ADOLESCENTS: FROM CLINICAL PRESENTATION TO RETURN TO SPORTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00020 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0002

Author(s):

Javier Besomi ◽

Alan Garin ◽

Cristhian Herrera ◽

Pedro Salgado ◽

Selim Abara ◽

...

Keyword(s):

Clinical Presentation ◽

Hip Pain ◽

Return To Sports ◽

X Rays ◽

Imaging Findings ◽

Duration Of Symptoms ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Ischiofemoral Impingement ◽

Quadratus Femoris

Background: Ischiofemoral impingement is an often unrecognized cause of hip pain in adolescents. It is caused by abnormal contact between the proximal femur and the ischium. The aim of our work is to describe clinical presentation, imaging findings and functional outcomes of ischiofemoral impingement in adolescents. Methods: We performed a retrospective study. Clinical files were reviewed (age, sex, type and duration of symptoms and hip physical examination). Imaging findings were evaluated in pelvis radiographs (presence of coxa profunda, acetabular protrusio, Wiberg angle, femoral neck shaft angle and acetabular retroversion) and in MRI (quadratus femoris edema, measurement of ischiofemoral and quadratus femoris space). Lower extremity functional scale (LEFS) were used to measured response to a physiotherapy protocol. Also relapse and time to sports return were recorded. Results: 24 hips, two bilateral in 20 female patients and 2 male patients, with 13 years-old on average (9-18) were obtained. Main symptom was hip pain with latency to consultant of 9 days on average (2-14). All patients practiced school sports, the most frequent was gymnastics. Positive FADIR test, ischiofemoral impingement test and pain on palpation of the ischium and gluteus medius were found in everyone. The median of Wiberg angle was 37º (25-48), femoral shaft angle 138º (128-144), and coxa profunda was present in 5 hips. MRI showed 13 hips with quadratus femoris edema, one with muscle atrophy, ischiofemoral space was 20 mm on average (16-25) and quadratus femoris space 17 mm on average (13-21). Our physiotherapy protocol was followed for all patients with a median of 18 sessions (10-30). LEFS improved from 56.4% (30-93) to 92% (80-100) (p=0,02). Time to turn asymptomatic was 6 months on average (3-13). With 2 years follow up, 2 hips had recurrence of symptoms. Time to sports return was 5 months on average (3-7). Conclusions: Ischiofemoral impingement is cause of hip pain in active female adolescents. X-rays are inespecific and MRI shows typically quadratus femoris edema. Conservative treatment with physiotherapy is an effective method that allows sports return in few months. This is the first report in the literature regards ischiofemoral impingement in pediatric population including results of treatment and return to sports.

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