Clinical and imaging evaluation of ischiofemoral impingement syndrome

Abstract

Ischiofemoral impingement syndrome is caused by the reduction of the anatomical space between the ischial tuberosity and the lesser femoral trochanter, causing compression of the soft structures that are normally housed in this space, particularly the quadratus femoris muscle. It manifests clinically in a non-specific manner, with predominant pain in the posterior region of the hip. However, this pain can extend to the gluteal, lumbar, sacroiliac, or trochanteric region; making its precise diagnosis difficult and being confused with other pathologies. Magnetic resonance imaging (MRI) is considered the diagnostic method of choice, allowing us to measure the ischiofemoral space and observe edema or trophic changes of the quadratus femoris muscle. Objective: To analyze the clinical and imaging findings in patients with symptoms of ischiofemoral impingement.

Retrospective study carried out in a medical care institution during a period of six years (January 2014 to December 2019). The sample included adult patients of both sexes who presented symptoms suggestive of ischiofemoral impingement. After taking the anamnesis and specific physical examination, radiological studies and magnetic resonance imaging (MRI) of the hips and lumbosacral spine were requested. 

82 patients were included, of whom 53 were male and 29 female, with a mean age of 44 years (range 19 to 58). In 9 cases (11%) the diagnosis of ischiofemoral impingement was confirmed (7 males and 2 females). The other cases with suspected ischiofemoral syndrome were diagnosed with lumbar disc disease (34.1%), femoroacetabular friction (22.7%), hip osteoarthritis (19%), trochanteric bursitis (16.3%) and sacroiliitis (7.9%). 

Ischiofemoral impingement is a rare entity with non-specific symptoms, which makes its clinical diagnosis difficult. However, a meticulous approach to the history, physical examination, and imaging studies is essential for its accurate diagnosis. Despite this, we must consider other pathologies, which may have a similar clinical presentation.