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Acute Obturator Externus Injury in Professional Soccer Players: A Case Series. Medicina (B Aires) 2022; 58:medicina58091145. [PMID: 36143822 PMCID: PMC9504638 DOI: 10.3390/medicina58091145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
When patients present with hip or groin pain, proximal quadriceps or adductor injuries are often initially suspected. In this case report, however, we present three cases of professional soccer players who were found to have obturator externus injury. A 30-year-old player and a 24-year-old player complained of pain in the left side after long distance shooting during an in-season training session and a match, respectively. Another 24-year-old player complained of pain in the right side after long distance passing during a preseason training session. On physical examination, active hip external rotation and passive hip internal rotation and extension elicited pain in all three players. All three players underwent magnetic resonance imaging (MRI) which found obturator externus grade II injuries for two players and grade I injury for one player. Rehabilitation protocols included relative rest, cryotherapy, and electrotherapy over a period of one week. All patients were able to return to play after 10 days. Correct identification of obturator externus injury afforded our players a favorable prognosis and a relatively quick return-to-sport compared with quadricep or adductor injury.
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Jeyaraman M, Murugan J, Maffulli N, Jeyaraman N, Potty AG, Gupta A. Ischiofemoral impingement syndrome: a case report and review of literature. J Orthop Surg Res 2022; 17:393. [PMID: 35986379 PMCID: PMC9392291 DOI: 10.1186/s13018-022-03287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The etiology of ischiofemoral impingement (IFI) syndrome, an unusual and uncommon form of hip pain, remains uncertain. Some patients demonstrate narrowing of the space between the ischial tuberosity and lesser trochanter from trauma or abnormal morphology of the quadratus femoris muscle. Combined clinical and imaging aid in the diagnosis.
Case report A 32-year-old female presented with a 3 years history of pain over the lower aspect of the right buttock, aggravated by movements of the right hip, and partially relieved with rest and medications. The right hip showed extreme restriction of abduction and external rotation. MRI of the right hip showed reduced ischiofemoral space and quadratus femoris space when compared to the left hip. The patient underwent endoscopic resection of the right lesser trochanter, with no recurrence of pain at 2 years.
Conclusion An unusual cause of hip pain, IFI syndrome, should be suspected when hip pain at extremes of movement is associated with signal abnormality of quadratus femoris muscle. Management is tailored to address the inciting factors that precipitated the IFI syndrome.
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Güney B, Doğan E, Özdemir MY. Osteochondroma as a Cause of Ischiofemoral Impingement - First Case Series. Acta Med Litu 2021; 28:189-194. [PMID: 34393644 PMCID: PMC8311847 DOI: 10.15388/amed.2021.28.1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
Ischiofemoral impingement (ISFI)is the compression of the quadratus femoris muscle resulting from the narrowed distance between the lesser trochanter and the ischial bone. Congenital factors (such as developmental hip dysplasia), positional conditions (such as femoral anteversion), intertrochanteric fractures, osteotomy, and osteoarthritis may lead to the superior and medial displacement of the femur which is causing the ISFI. According to the literature, osteochondroma (OC) is not described among the main etiological factors of ISFI. There is only one case report about the relationship between ISFI and OC. We present two ISFI cases due to OC accompanied by radiological findings. Our patients are 19 and 32 years old. Our article is the first case series on this topic.
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Affiliation(s)
- Bünyamin Güney
- Muğla Sıtkı Koçman University, Faculty of Medicine, Radiology, Turkey
| | - Emrah Doğan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Radiology, Turkey
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4
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Reintgen C, Bruner M, Smith MS, Moser M. Traumatic Obturator Internus and Quadratus Femoris Injury in a Pediatric Patient: A Case Report. Sports Health 2021; 13:387-389. [PMID: 33541258 DOI: 10.1177/1941738120984144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 11-year-old White female patient with a traumatic quadratus femoris and obturator internus tear after a sprint while at school. She felt immediate pain, swelling, and point tenderness in her posterosuperior thigh with a severely antalgic gait. Magnetic resonance imaging demonstrated a quadratus femoris tear, obturator internus tear, and ischial spine avulsion fracture. Although a less common etiology for acute hip pain in the pediatric population, traumatic injury to the short external rotators should not be excluded. The prognosis is favorable with a full return to previous activities expected using an appropriate rehabilitation program.
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Affiliation(s)
- Christian Reintgen
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
| | - Michelle Bruner
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
| | - M Seth Smith
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
| | - Michael Moser
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
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Girolami M, Tonetti L, Pipola V, Rimondi E, Albisinni U, Ricci A, Gasbarrini A. Quadratus Femoris muscle causing deep gluteal syndrome: A rare cause of refractory sciatica of extraspinal origin in the presence of an anatomic variation. J Back Musculoskelet Rehabil 2019; 32:667-670. [PMID: 31282403 DOI: 10.3233/bmr-191523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sciatica of extraspinal origin represents both a diagnostic and a therapeutic challenge for spine specialists. Among these, quadratus femoris muscle (QF) is often overlooked as a pain-generator. REPORTED CASE A 62-year old man was referred from general practitioner for isolated sciatica in the left leg, refractory to conservative treatments. Plain x-rays of the spine did not show any pathological finding nor did magnetic resonance imaging (MRI). MRI and CT showed QF with unusual morphologic features and agenesis of the contralateral QF. Ultrasonography-guided injection in the muscle was performed with mepivacaine and methylprednisolone obtaining relief of the symptoms. DISCUSSION Leg pain can be very disabling and, when combined with a normal MRI of the spine, diagnosis can be tricky. Several causes of sciatica of extraspinal origin have been described, some of them originating from the so-called "deep gluteal space". Anecdotal communications on anatomical variations of the quadratus femoris muscle are reported in literature. CONCLUSIONS Differential diagnosis of sciatica of extraspinal origin must rule out sacroiliac and hip joint so as deep gluteal space structures. Among these, quadratus femoris muscle is often overlooked as a pain-generator. Ultrasonography-guided intramuscular injections and a program of stretching and strengthening exercises can achieve durable control on the symptoms.
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Affiliation(s)
- Marco Girolami
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Laura Tonetti
- Department of Diagnostic and Interventional Radiology, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Eugenio Rimondi
- Department of Diagnostic and Interventional Radiology, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Ugo Albisinni
- Department of Diagnostic and Interventional Radiology, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Alessandro Ricci
- Department of Anesthesia-Resuscitation and Intensive Care, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
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Girdwood M, West L, Connell D, Brukner P. Contact-Related Strain of Quadratus Femoris, Obturator Externus, and Inferior Gemellus in an Australian Football Player: A Case Report. J Sport Rehabil 2019; 28:887-890. [PMID: 30747560 DOI: 10.1123/jsr.2018-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Muscle injuries of the hip stabilizers are considered rare in sport. OBJECTIVE This report presents a previously unreported case of a contact injury resulting in acute strain of quadratus femoris, obturator externus, and inferior gemellus in an amateur Australian rules football player. DESIGN Level 4-case report. CASE PRESENTATION A player was tackled ipsilateral to the injured leg, while in hip flexion in a lunged position. The case describes the diagnostic process, initial management, and return to play for this athlete. RESULTS Following rehabilitation, the player was able to return to sport at 8 weeks without ongoing issues. CONCLUSIONS A literature search for sports-related contact injuries to either muscle returned only one result. All other documented cases of injury to these muscle groups are confined to noncontact mechanisms or delayed presentations. Despite conventional teaching, the action of the deep external rotators of the hip appears to be positionally dependent. Knowledge of this type of injury and mechanism may be useful for future clinical reasoning and differential diagnosis in patients with this type of presentation.
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7
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Wong-On M, Turmo-Garuz A, Arriaza R, Gonzalez de Suso JM, Til-Perez L, Yanguas-Leite X, Diaz-Cueli D, Gasol-Santa X. Injuries of the obturator muscles in professional soccer players. Knee Surg Sports Traumatol Arthrosc 2018; 26:1936-1942. [PMID: 28188336 DOI: 10.1007/s00167-017-4453-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players. METHODS Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible. RESULTS Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5 ± 8.8 days. CONCLUSION Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Antonio Turmo-Garuz
- Universitat de Barcelona, Barcelona, Spain.,RCD Espanyol de Barcelona, Barcelona, Spain.,CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Rafael Arriaza
- Instituto Médico Arriaza y Asociados, Cátedra de Traumatología del Deporte HM Universidad da Coruña, La Coruña, Spain
| | | | - Luis Til-Perez
- CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Spain.,Medical Service, Football Club Barcelona, Barcelona, Spain
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Anandkumar S. Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A case report. Physiother Theory Pract 2017; 34:157-164. [PMID: 28922048 DOI: 10.1080/09593985.2017.1376021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This case report describes a 40-year-old male who presented with posterior thigh pain managed unsuccessfully with massage therapy, chiropractic adjustments, and physical therapy. The diagnosis of myofascial pain syndrome (MPS) involving the quadratus femoris (QF) was purely clinical, based on palpatory findings and ruling out other conditions through deductive reasoning. This is potentially a first time report, describing the successful management of MPS of the QF with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 4-month follow-up.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist, CBI Health Centre , Chilliwack , British Columbia , Canada
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Abstract
We present a case of a female patient with left groin pain after intense yoga exercises. The patient presented abnormal pattern of gait with no swelling over the groin, thigh, or buttock. Magnetic resonance imaging demonstrated a tear of the quadratus femoris muscle with an associated extensive hematoma formation. Patient was treated with a rehabilitation program consisting of nonsteroidal anti-inflammatory drugs and physiotherapy. At the follow-up control, the patient had improved her pain and flexibility of the hip, and gradually she returned to daily activities and yoga exercises. Such an entity is a rare cause of hip pain after exercise and should be kept in mind by the orthopedic surgeon, in cases of gluteal pain after intense physical activity. Moreover, such a condition should be included in the diagnostic algorithm of unknown origin hip pain.
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10
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Palczewski P, Sułkowska K, Świątkowski J, Kocoń H, Gołębiowski M. Ischiofemoral Impingement Syndrome: A Case Report and a Review of Literature. Pol J Radiol 2015; 80:496-8. [PMID: 26600879 PMCID: PMC4638133 DOI: 10.12659/pjr.894523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/24/2015] [Indexed: 11/14/2022] Open
Abstract
Background Ischiofemoral impingement syndrome is characterized by a hip pain associated with abnormalities in quadriceps femoris muscle and ipsilaterally reduced distance between the lesser trochanter and the ischium. Thus far, the congenital variant of this entity has been reported exclusively in women. Case Report We report a case of a 22-year old male with painful hips in whom on the basis of the imaging studies the constitutional variant of ischiofemoral impingement was diagnosed. Conclusions Ischiofemoral conflict should be taken into consideration in the differential diagnosis of hip pain, particularly among women, but also in patients with valgus hip deformity and other abnormalities leading to reduction of the space between femoral and ischial bones independent of gender.
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Affiliation(s)
- Piotr Palczewski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Sułkowska
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Jan Świątkowski
- Department of Orthopaedics and Traumatology of Locomotor System, Medical University of Warsaw, Warsaw, Poland
| | - Hanna Kocoń
- Department of Orthopaedics and Traumatology of Locomotor System, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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Khodaee M, Jones D, Spittler J. Obturator Internus and Obturator Externus Strain in a High School Quarterback. Asian J Sports Med 2015; 6:e23481. [PMID: 26448844 PMCID: PMC4594131 DOI: 10.5812/asjsm.23481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/08/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction: Buttock pain is a relatively common complaint among adolescent athletes and can have a very broad differential diagnosis. Case Presentation: The authors present a previously unreported case of acute obturator internus and obturator externus strain in an adolescent male American football player. The diagnosis was made by MRI. The patient was treated with relative rest, physical therapy, and gradual return to physical activities as tolerated. Conclusions: Despite rarity of the hip external rotator muscles strains, it should be considered in the differential diagnosis of athletes with proximal posterior thigh and buttock pain.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
- Corresponding author: Morteza Khodaee, Department of Family Medicine, University of Colorado School of Medicine, 80238, Denver, USA. Tel: +1-7208489056, Fax: +1-7208489050, E-mail:
| | - Daniel Jones
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
| | - Jack Spittler
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
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12
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Semciw AI, Freeman M, Kunstler BE, Mendis MD, Pizzari T. Quadratus femoris: An EMG investigation during walking and running. J Biomech 2015; 48:3433-9. [PMID: 26116043 DOI: 10.1016/j.jbiomech.2015.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/01/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
Dysfunction of hip stabilizing muscles such as quadratus femoris (QF) is identified as a potential source of lower extremity injury during functional tasks like running. Despite these assumptions, there are currently no electromyography (EMG) data that establish the burst activity profile of QF during any functional task like walking or running. The objectives of this study were to characterize and compare the EMG activity profile of QF while walking and running (primary aim) and describe the direction specific action of QF (secondary aim). A bipolar fine-wire intramuscular electrode was inserted via ultrasound guidance into the QF of 10 healthy participants (4 females). Ensemble curves were generated from four walking and running trials, and normalized to maximum voluntary isometric contractions (MVICs). Paired t-tests compared the temporal and amplitude EMG variables. The relative activity of QF in the MVICs was calculated. The QF displayed moderate to high amplitude activity in the stance phase of walking and very high activity during stance in running. During swing, there was minimal QF activity recorded during walking and high amplitudes were present while running (run vs walk effect size=4.23, P<0.001). For the MVICs, external rotation and clam produced the greatest QF activity, with the hip in the anatomical position. This study provides an understanding of the activity demands placed on QF while walking and running. The high activity in late swing during running may signify a synergistic role with other posterior thigh muscles to control deceleration of the limb in preparation for stance.
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Affiliation(s)
- Adam I Semciw
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; La Trobe University Sport, Exercise and Rehabilitation Research Focus Area, Bundoora, Victoria, Australia.
| | - Michael Freeman
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Breanne E Kunstler
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - M Dilani Mendis
- Centre for Musculoskeletal Research, Mary Mackillop Institute for Health Research, Australian Catholic University, Brisbane, Queensland, Australia
| | - Tania Pizzari
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; La Trobe University Sport, Exercise and Rehabilitation Research Focus Area, Bundoora, Victoria, Australia
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13
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Yoo S, Dedova I, Pather N. An appraisal of the short lateral rotators of the hip joint. Clin Anat 2015; 28:800-12. [PMID: 26032283 DOI: 10.1002/ca.22568] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022]
Abstract
The short lateral rotators (piriformis, obturator internus, superior and inferior gemelli, obturator internus, and quadratus femoris) are functionally important muscles, significantly contributing to hip joint stability. They act as "postural muscles", holding the femoral head in the acetabulum during hip movements, thus are frequently monitored in gait analysis and for muscle rehabilitation post-injury. Despite the need to precisely identify and repair these muscles for stability postoperatively, clinical complications have resulted from the inadequate and inconsistent understanding of their morphological and functional anatomy. Furthermore, the short lateral rotators have complex entheses (osteotendinous insertions on bone) and may be subject to overuse injury in sport. This study aims to review the reported morphology of the short lateral rotators in order to ascertain whether discrepancies exist in our understanding of these muscles, and if further investigation is required to aid in gait analysis, clinical management of hip pathologies, and prevention of overuse injuries. Following a literature search strategy, 59 primary references were retrieved from three databases, with additional 26 anatomical textbooks selected for critical evaluation. Numerous inaccuracies and inconsistencies in the anatomical descriptions of the attachments, patterns of innervation and actions exist, and often insufficiently supported by primary findings. There is also a paucity of information regarding the architectural pattern of the muscles, which would be useful in clarifying the function of these dynamic stabilizers of the hip joint. A better anatomical understanding of these muscles will better inform hip reconstruction and lead to improved surgical outcomes by reducing post-operative complications.
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Affiliation(s)
- Sarang Yoo
- Department of Anatomy, School of Medical Sciences, Medicine, UNSW Australia, Sydney, Australia
| | - Irina Dedova
- Department of Anatomy, School of Medical Sciences, Medicine, UNSW Australia, Sydney, Australia
| | - Nalini Pather
- Department of Anatomy, School of Medical Sciences, Medicine, UNSW Australia, Sydney, Australia
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14
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Sussman WI, Han E, Schuenke MD. Quantitative assessment of the ischiofemoral space and evidence of degenerative changes in the quadratus femoris muscle. Surg Radiol Anat 2012; 35:273-81. [DOI: 10.1007/s00276-012-1029-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 10/03/2012] [Indexed: 11/28/2022]
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15
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Truong WH, Murnaghan ML, Hopyan S, Kelley SP. Ischioplasty for Femoroischial Impingement: A Case Report. JBJS Case Connect 2012; 2:e51. [PMID: 29252549 DOI: 10.2106/jbjs.cc.k.00177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Walter H Truong
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, 200 University Avenue East, St. Paul, MN 55101.
| | - M Lucas Murnaghan
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, S107, Toronto, ON M5G 1X8, Canada. . .
| | - Sevan Hopyan
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, S107, Toronto, ON M5G 1X8, Canada. . .
| | - Simon P Kelley
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, S107, Toronto, ON M5G 1X8, Canada. . .
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16
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Yanagishita CMA, Falótico GG, Rosário DAV, Pugina GG, Wever AAN, Takata ET. ISCHIOFEMORAL IMPINGEMENT - AN ETIOLOGY OF HIP PAIN: CASE REPORT. Rev Bras Ortop 2012; 47:780-3. [PMID: 27047901 PMCID: PMC4799478 DOI: 10.1016/s2255-4971(15)30039-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/21/2011] [Indexed: 11/25/2022] Open
Abstract
An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause.
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Affiliation(s)
| | | | - Davi Araújo Veiga Rosário
- Resident, Department of Orthopedics and Traumatology, Paulista School of Medicine - Unifesp - São Paulo, SP, Brazil
| | | | | | - Edmilson Takehiro Takata
- Head, Hip Group, Paulista School of Medicine - Unifesp; Master's degree in Orthopedics by the Paulista School of Medicine - Unifesp - São Paulo, SP, Brazil
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17
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Miokovic T, Armbrecht G, Felsenberg D, Belavy DL. Differential atrophy of the postero-lateral hip musculature during prolonged bedrest and the influence of exercise countermeasures. J Appl Physiol (1985) 2011; 110:926-34. [PMID: 21233337 DOI: 10.1152/japplphysiol.01105.2010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As part of the 2nd Berlin BedRest Study (BBR2-2), we investigated the pattern of muscle atrophy of the postero-lateral hip and hamstring musculature during prolonged inactivity and the effectiveness of two exercise countermeasures. Twenty-four male subjects underwent 60 days of head-down tilt bedrest and were assigned to an inactive control (CTR), resistive vibration exercise (RVE), or resistive exercise alone (RE) group. Magnetic resonance imaging (MRI) of the hip and thigh was taken before, during, and at end of bedrest. Volume of posterolateral hip and hamstring musculature was calculated, and the rate of muscle atrophy and the effect of countermeasure exercises were examined. After 60 days of bedrest, the CTR group showed differential rates of muscle volume loss (F = 21.44; P ≤ 0.0001) with fastest losses seen in the semi-membranosus, quadratus femoris and biceps femoris long head followed by the gluteal and remaining hamstring musculature. Whole body vibration did not appear to have an additional effect above resistive exercise in preserving muscle volume. RE and RVE prevented and/or reduced muscle atrophy of the gluteal, semi-membranosus, and biceps femoris long head muscles. Some muscle volumes in the countermeasure groups displayed faster recovery times than the CTR group. Differential atrophy occurred in the postero-lateral hip musculature following a prolonged period of unloading. Short-duration high-load resistive exercise during bedrest reduced muscle atrophy in the mono-articular hip extensors and selected hamstring muscles. Future countermeasure design should consider including isolated resistive hamstring curls to target this muscle group and reduce the potential for development of muscle imbalances.
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Affiliation(s)
- Tanja Miokovic
- Centre for Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Bano A, Karantanas A, Pasku D, Datseris G, Tzanakakis G, Katonis P. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report. J Med Case Rep 2010; 4:236. [PMID: 20678222 PMCID: PMC2923169 DOI: 10.1186/1752-1947-4-236] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 08/02/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. CASE PRESENTATION We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. CONCLUSION The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.
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Affiliation(s)
- Artan Bano
- Department of Orthopaedic and Traumatology, University Hospital of Heraklion, 71110, Crete, Greece.
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Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med 2008; 36:1799-804. [PMID: 18448581 DOI: 10.1177/0363546508315892] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring strains can be of at least 2 types, 1 occurring during high-speed running and the other during motions in which the hamstring muscles reach extreme lengths, as documented for sprinters and dancers. HYPOTHESIS Hamstring strains in different sports, with similar injury situations to dancers, also show similarities in symptoms, injury location, and recovery time. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Thirty subjects from 21 different sports were prospectively included. All subjects were examined clinically and with magnetic resonance imaging (MRI). The follow-up period lasted until the subjects returned to or finished their sport activity. RESULTS All injuries occurred during movements reaching a position with combined extensive hip flexion and knee extension. They were located proximally in the posterior thigh, close to the ischial tuberosity. The injuries were often complex, but 83% involved the semimembranosus and its proximal free tendon. Fourteen subjects (47%) decided to end their sports activity. For the remaining 16 subjects, the median time for return to sport was 31 weeks (range, 9-104). There were no significant correlations between specific clinical or MRI parameters and time to return to sport. CONCLUSIONS In different sports, an injury situation in which the hamstring muscles reach extensive length causes a specific injury to the proximal posterior thigh, earlier described in dancers. Because of the prolonged recovery time associated with this type of injury, correct diagnosis, based on history and palpation, and adequate information to the subject are essential.
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Affiliation(s)
- Carl M Askling
- Swedish School of Sport and Health Sciences, Stockholm, Sweden.
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Abstract
OBJECTIVE The objective of this study is to report the MR appearance of quadratus femoris muscle tear, another cause of hip pain. We will review the pertinent anatomy of the quadratus femoris muscle, summarize the current literature on quadratus femoris muscle tear, and report our experience in the diagnosis of quadratus femoris muscle tear on MRI. CONCLUSION MRI is an important tool in assisting clinicians to make a correct diagnosis for the patient who presents with hip pain. Although quadratus femoris muscle tear is an uncommon injury, radiologists should be aware of this entity to assist with making a diagnosis that is usually unsuspected clinically.
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Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during slow-speed stretching: clinical, magnetic resonance imaging, and recovery characteristics. Am J Sports Med 2007; 35:1716-24. [PMID: 17567821 DOI: 10.1177/0363546507303563] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises. HYPOTHESIS A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time. STUDY DESIGN Case series (prognosis); Level of evidence, 2. METHODS Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. RESULTS All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semimembranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30-76 weeks). CONCLUSION Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.
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Affiliation(s)
- Carl M Askling
- Swedish School of Sport and Health Sciences, Stockholm, Sweden.
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Armfield DR, Kim DHM, Towers JD, Bradley JP, Robertson DD. Sports-related muscle injury in the lower extremity. Clin Sports Med 2006; 25:803-42. [PMID: 16962427 DOI: 10.1016/j.csm.2006.06.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Derek R Armfield
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Robinson G, Hine AL, Richards PJ, Heron CW. MRI abnormalities of the external rotator muscles of the hip. Clin Radiol 2005; 60:401-6. [PMID: 15710147 DOI: 10.1016/j.crad.2004.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Robinson
- Department of Radiology, St George's Hospital, London, UK
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