1
|
Mayo-Juanatey A, García-Ferrer L, Ballester-Suárez A, Valls-Pascual E, Vázquez-Gómez I, Alegre-Sancho JJ. Ischiofemoral impingement syndrome: A five-case series report. REUMATOLOGIA CLINICA 2024; 20:162-165. [PMID: 38443229 DOI: 10.1016/j.reumae.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 03/07/2024]
Abstract
Gluteal pain is a frequent cause of medical attention in the daily clinical practice. It can be caused by multiple pathologies, being ischiofemoral impingement syndrome among those included in its differential diagnosis. Encompassed within the deep gluteal syndromes, this entity occurs as a consequence of the entrapment of the neuromuscular structures between the lesser femoral trochanter and the ischial tuberosity, causing pain in the root of the lower limb, with irradiation towards the thigh or the gluteal region and poor tolerance to deambulation and sedestation. The magnetic resonance imaging of the hip is fundamental for its diagnosis, and its management consists on medical treatment at onset. Despite not being a frequent diagnosis in the clinical practice in Rheumatology, keeping it in mind helps improving its prognosis by establishing an early and adequate treatment.
Collapse
Affiliation(s)
| | - Luís García-Ferrer
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset. Valencia. Spain
| | | | - Elia Valls-Pascual
- Servicio de Reumatología, Hospital Universitari Doctor Peset. Valencia, Spain
| | | | | |
Collapse
|
2
|
Sahr ME, Endo Y, Sink EL, Miller TT. Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement. Skeletal Radiol 2023; 52:1385-1393. [PMID: 36598522 DOI: 10.1007/s00256-022-04264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In this technical report, we describe our protocol for the dynamic sonographic evaluation of the hip and assess reliability of the ultrasound assessment of hip microinstability. MATERIALS AND METHODS Our clinical experience with a standardized dynamic ultrasound of the hip performed in a series of 27 patients with imaging performed by an experienced musculoskeletal radiologist during physical examination by an orthopedic surgeon specializing in hip preservation is illustrated with clinical photographs and ultrasound images from volunteers and selected patients. Interrater reliability for the diagnosis of microinstability was calculated. RESULTS Dynamic ultrasound technique and findings of hip instability, femoroacetabular impingement, and ischiofemoral impingement with corresponding clinical photos showing the necessary physical examination maneuvers are described. Interrater agreement for the diagnosis of microinstability was substantial (κ 0.606 [0.221-0.991]). CONCLUSION At our institution, dynamic ultrasound of the hip during physical examination complements information gathered from static imaging by providing real-time correlation of symptoms with what is occurring anatomically.
Collapse
Affiliation(s)
- Meghan E Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA.
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Dablan A, Oktay C, Çevikol C. Ischiofemoral Impingement Syndrome: Effect of Morphological Variations on the Diagnosis. Curr Med Imaging 2021; 17:595-601. [PMID: 33213330 DOI: 10.2174/1573405616666201118124715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study is to clarify which morphologic variations of the hip on MRI are associated with the development of ischiofemoral impingement. METHODS Hip MRIs of patients who have been referred to our department between 2016-2017 were retrospectively reviewed and assessed for pathological signal changes in the quadratus femoris muscle and ipsilateral hip or buttock pain. After assessment, ischial angle, inclination angle, ischiofemoral space, quadratus femoris space, intertuberous distances and femur neck angle, femoral torsion angle and knee angle were measured and compared in 37 hips of 20 patients and 56 hips of 28 age-gender matched control subjects. RESULTS There were statistically significant differences between the patient and control groups in all MRI parameters except for intertuberous distances (p<0.05). Quadratus femoris space (p<0.001) and ischiofemoral space (p<0.001) were significantly lower and femoral torsion angle (p=0.02), femur neck angle (p=0.001), ischial angle (p=0.01) and inclination angle (p=0.03) values were significantly higher in patients compared with the control group. CONCLUSION Decreased ischiofemoral space and quadratus femoris space, increased femoral torsion angle, femur neck angle, ischial angle and inclination angle are found to be associated with IFI on MRI. These pelvic anatomical variations may predispose to ischiofemoral impingement and should be kept in mind for patients with hip pain.
Collapse
Affiliation(s)
- Ali Dablan
- Akdeniz University School of Medicine, Department of Radiology, TR-07070, Antalya, Turkey
| | - Cemil Oktay
- Adıyaman University Education and Research Hospital, Department of Radiology, TR-02200, Adıyaman, Turkey
| | - Can Çevikol
- Akdeniz University School of Medicine, Department of Radiology, TR-07070, Antalya, Turkey
| |
Collapse
|
5
|
Vogrin M, Ličen T, Kljaić Dujić M. Ischiofemoral Impingement Syndrome: An Overview for Strength and Conditioning Professionals. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Vicentini JRT, Martinez-Salazar EL, Simeone FJ, Bredella MA, Palmer WE, Torriani M. Kinematic MRI of ischiofemoral impingement. Skeletal Radiol 2021; 50:97-106. [PMID: 32638058 DOI: 10.1007/s00256-020-03519-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the effect of external hip rotation on ischiofemoral (IF) and quadratus femoris (QF) spaces using real-time kinematic MRI, with the hypothesis that hips with IF and QF space narrowing have distinct motion patterns compared with control hips. MATERIALS AND METHODS This prospective study was IRB-approved and complied with HIPAA guidelines. We recruited women (≥ 18 years) with and without ischiofemoral impingement to undergo kinematic MRI of the hips. A kinematic imaging protocol using T2-HASTE was performed beginning at maximal internal rotation followed by active external hip rotation. The duration of each acquisition was 30 s, providing 8 images/3 s. IF and QF spaces, and femoral metaphyseal and lesser trochanter centroid coordinates were measured on sequential images. Hips were classified as controls or narrowed based on IF and QF space thresholds and compared statistically throughout motion stages. RESULTS The cohort comprised 12 women (24 hips; 10 control and 14 narrowed hips) aged 58 ± 10 years. External rotation caused IF space reduction of 59% in narrowed hips versus 41% in control hips. QF space decreased 71% in narrowed hips versus 50% in control hips. IF and QF spaces differed significantly between groups only when external rotation exceeded the neutral position (P < 0.02 for both). The lesser trochanter terminated more posteriorly in narrowed hips compared with controls (P = 0.03). CONCLUSIONS Kinematic MRI during external hip rotation in women with narrowed and control hips reveals dynamic differences in IF and QF spaces and lesser trochanter terminal position.
Collapse
Affiliation(s)
- Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Edgar L Martinez-Salazar
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - William E Palmer
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachussetts General Hospital, 55 Fruit Street YAW 6, Boston, MA, 02114, USA.
| |
Collapse
|
7
|
Singaravadivelu V, Abraham AW. Ischiofemoral Impingement Syndrome Secondary to Arteriovenous Malformation of the Quadratus Femoris: A Case Report. JBJS Case Connect 2020; 10:e19.00326. [PMID: 33512926 DOI: 10.2106/jbjs.cc.19.00326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Ischiofemoral impingement syndrome (IFIS), an unusual presentation of hip pain, is frequently missed in clinical practice. We report a case of a 27-year-old man with complaints of gradual onset nonprogressive right gluteal pain with hip movement restriction for the past 5 years that was not relieved with conservative measures. Right hip magnetic resonance imaging revealed a vascular abnormality of the right quadratus femoris muscle suggestive of IFIS. This abnormal muscle was surgically excised, and its histologic evaluation was remarkable for an arteriovenous malformation. CONCLUSION The patient's longstanding symptomatic IFIS was ultimately attributed to a rare arteriovenous malformation of the quadratus femoris that resolved with surgical excision.
Collapse
|
8
|
Nakano N, Shoman H, Khanduja V. Treatment strategies for ischiofemoral impingement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:2772-2787. [PMID: 30426139 PMCID: PMC7471170 DOI: 10.1007/s00167-018-5251-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 10/22/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE There has been relatively little information about the treatment for ischiofemoral impingement (IFI) because of its rarity as well as the uncertainty of diagnosis. The aim of this study was to provide the reader with the available treatment strategies and their related outcomes for IFI based on the best available evidence, whilst highlighting classically accepted ways of treatment as well as relatively new surgical and non-surgical techniques. METHODS A systematic review of the literature from Medline, Embase, AMED, Cochrane and Google Scholar was undertaken since inception to December 2017 following the PRISMA guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the treatment outcome for IFI were included. Animal or cadaveric studies, trial protocols, diagnostic studies without any description of treatments, technical notes without any results, and review articles were excluded. RESULTS This systematic review found 17 relevant papers. No comparative studies were included in the final records for qualitative assessment, which means all the studies were case series and case reports. Eight studies (47.1%) utilised non-surgical treatment including injection and prolotherapy, followed by endoscopic surgery (5 studies, 29.4%) then open surgery (4 studies, 23.5%). Mean age of the participants was 41 years (11-72 years). The mean follow-up was 8.4 months distributed from 2 weeks to 2.3 years. No complications or adverse effects were found from the systematic review. CONCLUSION Several treatment strategies have been reported for IFI, and most of them have good short- to medium-term outcomes with a low rate of complications. However, there are no comparative studies to assess the superiority of one technique over another, thus further research with randomised controlled trials is required in this arena. This study explores the wide variety and categories of different treatments used for IFI to guide physicians and shed light on what can be done for this challenging cohort of patients. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Naoki Nakano
- grid.24029.3d0000 0004 0383 8386Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke’s-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ UK
| | - Haitham Shoman
- grid.24029.3d0000 0004 0383 8386Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke’s-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery - Young Adult Hip Service, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 37, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
9
|
Kivlan BR, Martin RL. Editorial Commentary: A-version to a Pain in the Butt-Structural and Dynamic Determinants of Posterior Hip Pain. Arthroscopy 2020; 36:156-158. [PMID: 31864570 DOI: 10.1016/j.arthro.2019.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
Ischiofemoral impingement is becoming a more recognized source of buttock pain that occurs as the lesser trochanter of the femur approximates the lateral margin of the ischium. Abnormal bony structure and alignment of the hip joint and/or faulty dynamic movement patterns may decrease the ischiofemoral space and compress the structures that are found within the space, including the quadratus femoris, proximal hamstring tendons, and sciatic nerve. The ischiofemoral space is reduced by structural factors including an increase in femoral anteversion and femoral neck angle. Dynamic assessment of the hip region may include the Craig test and total rotational range of motion of the hip joint, as well as the ischiofemoral impingement test and the long-stride walking test. The combination of structural and dynamic assessment of the hip region may help determine the presence of ischiofemoral impingement and direct appropriate management of the condition.
Collapse
Affiliation(s)
| | - RobRoy L Martin
- Duquesne University, John G Rangos Sr. School of Health Sciences
| |
Collapse
|
10
|
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.
Collapse
|
11
|
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.
Collapse
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
| | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is useful in evaluating nontraumatic hip pain. It provides information about associated injuries like labral/chondral tears or ischiofemoral impingement (IFI). However, in hereditary multiple exostoses (HME) there has been no report about MRI findings in symptomatic children with hip involvement. METHODS Records of children with HME and hip osteochondromas, who had hip MRI/magnetic resonance arthrography, were reviewed. The presence of chondral lesions and labral tears, as well the presence of IFI, was recorded. IFI was defined as edema or fatty replacement/atrophy in the quadratus femoris muscle or decrease of the space for this muscle between the ischium and the proximal femur. The measurements used to determine the space included the ischiofemoral space, the quadratus femoris space, and the minimum ischiofemoral space (MIFS). All measurements were performed on axial T1-weighted images. RESULTS Ten children were included (4 males, 6 females). In 2 patients, MRI was unilateral, therefore a total of 18 hips were analyzed. The indication for MRI was hip pain. Mean age, when MRI was performed, was 11.7 years. Labral tears were found in 44% (8/18) and chondral lesions in 33% (6/18) of the hips. The mean ischiofemoral space was 17.2 mm (SD, 7.3), the mean quadratus femoris space was 14.9 mm (SD, 5.3), and the mean MIFS was of 12.8 mm (SD, 5.9). IFI was seen in 44% (8/18) of hips. Two patients had bilateral IFI. MIFS was <10 mm in all hips with IFI (8/8). Of these hips, 88% (7/8) had edema of the quadratus femoris muscle and 38% (3/8) had fatty replacement/atrophy in the muscle. Osteochondromas were seen in the lesser trochanter in all hips with IFI (8/8) and in the ischium in 50% of them (4/8). CONCLUSIONS In symptomatic children with HME of the hip, MRI is helpful in detecting the source of pain. A high percentage of these children have IFI and intra-articular lesions. These findings can play an important role in the indication and planning of the surgical approach. LEVEL OF EVIDENCE Level IV-diagnostic study.
Collapse
|
13
|
de Carvalho AD, Garcia FL, Nogueira-Barbosa MH. Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report. Radiol Bras 2017; 50:335-337. [PMID: 29085168 PMCID: PMC5656075 DOI: 10.1590/0100-3984.2013.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report an unusual case of ischiofemoral impingement secondary to valgus
intertrochanteric osteotomy. The osteotomy was performed for treatment of
epiphysiolysis of the left femoral head.
Collapse
Affiliation(s)
- Alice Duarte de Carvalho
- Fellow in Musculoskeletal Radiology, Radiology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Flávio Luís Garcia
- Associate Professor, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Associate Professor, Division of Radiology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist, CBI Health Centre , Chilliwack , British Columbia , Canada
| |
Collapse
|
15
|
Ischiofemoral impingement: defining the lesser trochanter-ischial space. Knee Surg Sports Traumatol Arthrosc 2017; 25:72-76. [PMID: 26869034 DOI: 10.1007/s00167-016-4036-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to define changes in the ischial-lesser trochanteric space associated with medial and lateral hip rotation in neutral and 10° of extension and adduction. METHODS Twenty-five hip joints from 14 embalmed cadavers (7 males and 7 females) were used for this study. The pelvic region of each cadaver was skeletonized, and the hip capsule released distally. With the hip joint in 0° flexion-extension/abduction-adduction, the distance between the lesser trochanter and ischium was measured in: neutral rotation, 40° medial rotation, and 60° lateral rotation. A one-way ANOVA with post hoc analysis determined the difference in the ischiofemoral space in these three positions. An additional position was then tested by laterally rotating the femur with the hip joint positioned in 10° extension and adduction. RESULTS The average distance between the lesser trochanter and ischium was different (p < .0005) in neutral rotation, 40° medial rotation, and 60° lateral rotation at 2.8 cm (SD 1.1), 4.3 cm (SD 1.2), and 1.4 cm (SD 0.7), respectively. With the hip joint laterally rotated from a starting position of 10° extension and adduction, 21 of 25 (84 %) hips made contact between the lesser trochanter and ischium at an average position of 29° (SD 20) of lateral rotation. CONCLUSIONS The lesser trochanter is closest to the ischium in lateral rotation and is furthest away in medial rotation when the hip is in neutral flexion-extension/abduction-adduction. The lesser trochanter approximates the ischium when the hip is laterally rotated in 10° extension and adduction. The information gained through this investigation helps to define the pathomechanics associated with ischiofemoral impingement and validate clinical tests to diagnose ischiofemoral impingement.
Collapse
|
16
|
Spencer-Gardner L, Bedi A, Stuart MJ, Larson CM, Kelly BT, Krych AJ. Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion. Knee Surg Sports Traumatol Arthrosc 2017; 25:55-61. [PMID: 26429568 DOI: 10.1007/s00167-015-3812-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. METHODS All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). RESULTS Ten patients with a mean age of 18 years (range 14-28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7-3.5), the median post-operative mHHS was 89.7 (65.7-96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. CONCLUSION Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Asheesh Bedi
- Medsport Clinic University of Michigan, 24 Frank Lloyd Wright Dr Ste 1000, Ann Arbor, MI, 48105, USA
| | | | | | - Bryan T Kelly
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Aaron J Krych
- Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA.
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Finnoff JT, Johnson AC, Hollman JH. Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study. PM R 2016; 9:392-397. [PMID: 27418573 DOI: 10.1016/j.pmrj.2016.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/21/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ischiofemoral impingement is a potential cause of hip and buttock pain. It is evaluated commonly with magnetic resonance imaging (MRI). To our knowledge, no study previously has evaluated the ability of ultrasound to measure the ischiofemoral space (IFS) dimensions reliably. OBJECTIVE To determine whether ultrasound could accurately measure the IFS dimensions when compared with the gold standard imaging modality of MRI. DESIGN A methods comparison study. SETTING Sports medicine center within a tertiary-care institution. PARTICIPANTS A total of 5 male and 5 female asymptomatic adult subjects (age mean = 29.2 years, range = 23-35 years; body mass index mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. METHODS Subjects were secured in a prone position on a MRI table with their hips in a neutral position. Their IFS dimensions were then acquired in a randomized order using diagnostic ultrasound and MRI. MAIN OUTCOME MEASUREMENTS The main outcome measurements were the IFS dimensions acquired with ultrasound and MRI. RESULTS The mean IFS dimensions measured with ultrasound was 29.5 mm (standard deviation [SD] 4.99 mm, standard error mean 1.12 mm), whereas those obtained with MRI were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). The mean difference between the ultrasound and MRI measurements was 1.25 mm, which was not statistically significant (SD 3.71 mm, standard error mean 3.71 mm, 95% confidence interval -0.49 mm to 2.98 mm, t19 = 1.506, P = .15). The Bland-Altman analysis indicated that the 95% limits of agreement between the 2 measurement was -6.0 to 8.5 mm, indicating that there was no systematic bias between the ultrasound and MRI measurements. CONCLUSIONS Our findings suggest that the IFS measurements obtained with ultrasound are very similar to those obtained with MRI. Therefore, when evaluating individuals with suspected ischiofemoral impingement, one could consider using ultrasound to measure their IFS dimensions. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403(∗).
| | - Adam C Johnson
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN(†)
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN(‡)
| |
Collapse
|
19
|
Kivlan BR, Martin RL, Martin HD. Defining the greater trochanter-ischial space: a potential source of extra-articular impingement in the posterior hip region. J Hip Preserv Surg 2016; 3:352-357. [PMID: 29632696 PMCID: PMC5883177 DOI: 10.1093/jhps/hnw017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to describe greater trochanteric-ischial impingement and the relative position of the hip joint where impingement occurs. Twenty-three hips from 13 embalmed cadavers (seven males and six females) with a lifespan ranging between 46 and 91 years were used for this study. The pelvic region of each cadaver was skeletonized leaving only the hip capsule and the sciatic nerve. From 90° of flexion, the hip was extended while maintaining a position of 30° abduction and 60° external rotation. The position of hip flexion was recorded when there was contact between the greater trochanter and the ischium. The procedure was repeated in 0° abduction. A Flexion-Abduction-External Rotation (FABER) test was then performed on all specimens with a positive finding defined as contact between the greater trochanter and the ischium. In 30° abduction, contact of the ischium and the greater trochanter occurred in 87% (20/23) of the hips at an average of 47° of flexion (SD 10; range 20–60°). In 0° abduction, a positive finding was noted in 39% (9/23) of hips at an average of 59° flexion (SD 6; range 52–70°). A positive finding in the FABER test position was noted in 96% (22/23) of hips. The greater trochanter can impinge on the ischium when the hip is extended from 90° flexion in a 60° externally rotated position. This impingement occurred more commonly when the hip was in 30° abduction compared with neutral abduction. The FABER test position consistently created greater trochanteric–ischial impingement.
Collapse
Affiliation(s)
- Benjamin R Kivlan
- John G. Rangos Sr, School of Health Sciences, Duquesne University, Pittsburgh, PA 15282, USA.,Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - RobRoy L Martin
- John G. Rangos Sr, School of Health Sciences, Duquesne University, Pittsburgh, PA 15282, USA.,Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
| | - Hal D Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
20
|
Hernando MF, Cerezal L, Pérez-Carro L, Canga A, González RP. Evaluation and management of ischiofemoral impingement: a pathophysiologic, radiologic, and therapeutic approach to a complex diagnosis. Skeletal Radiol 2016; 45:771-87. [PMID: 26940209 DOI: 10.1007/s00256-016-2354-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/23/2016] [Accepted: 02/15/2016] [Indexed: 02/02/2023]
Abstract
Ischiofemoral impingement syndrome (IFI) is an underrecognized form of atypical, extra-articular hip impingement defined by hip pain related to narrowing of the space between the ischial tuberosity and the femur. The etiology of IFI is multifactorial and potential sources of ischiofemoral engagement include anatomic variants of the proximal femur or pelvis, functional disorders as hip instability, pelvic/spinal instability, or abductor/adductor imbalance, ischial tuberosity enthesopathies, trauma/overuse or extreme hip motion, iatrogenic conditions, tumors and other pathologies. Magnetic resonance imaging (MRI) is the diagnostic procedure of choice for assessing IFI and may substantially influence patient management. The injection test of the ischiofemoral space (IFS) has both a diagnostic and therapeutic function. Endoscopic decompression of the IFS appears useful in improving function and diminishing hip pain in patients with IFI but conservative treatment is always the first step in the treatment algorithm. Because of the ever-increasing use of advanced MRI techniques, the frequent response to conservative treatment, and the excellent outcomes of new endoscopic treatment, radiologists must be aware of factors that predispose or cause IFI. In addition, focused treatment in these conditions is often more important than in secondary impingement. In this article, we briefly describe the anatomy of the IFS, review the clinical examination and symptoms, assess the diagnostic imaging criteria and pathophysiological mechanisms, and develop an understandable classification of IFI, with particular focus on its etiology, predisposing factors, and associated musculoskeletal abnormalities. We also assess the role of the radiologist in the diagnosis, treatment, and preoperative evaluation of both primary and secondary IFI.
Collapse
Affiliation(s)
- Moisés Fernández Hernando
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Calle Castilla 6 Bajo, 39002, Santander, Cantabria, Spain.
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Calle Castilla 6 Bajo, 39002, Santander, Cantabria, Spain
| | - Luis Pérez-Carro
- Orthopedic Surgery Department, Clínica Mompía, Santander, Cantabria, Spain
| | - Ana Canga
- Department of Radiology, Valdecilla University Hospital, Santander, Cantabria, Spain
| | | |
Collapse
|
21
|
Supine Versus Standing Radiographs for Detecting Ischiofemoral Impingement: A Propensity Score-Matched Analysis. AJR Am J Roentgenol 2016; 206:1253-63. [PMID: 27070951 DOI: 10.2214/ajr.15.15186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess parameters of ischiofemoral impingement on supine and standing anteroposterior hip radiographs and to suggest optimal cutoff points for detection of ischiofemoral impingement. MATERIALS AND METHODS A retrospective study included patients with a clinical history of hip pain. All hip joints with evidence of quadratus femoris muscle edema on MR images were included in the ischiofemoral impingement patient group. An age- and sex-matched control group was derived from the same cohort by propensity score matching. On radiographs, two readers independently measured the following parameters: ischiofemoral space, quadratus femoris space, hamstring tendon area, ischiofemoral distance on supine radiograph, ischiofemoral distance on standing radiograph, and femoral neck-shaft angle. Group differences in parameters were assessed by Mann-Whitney U test. The intraclass correlation coefficient and the ROC AUC were obtained. Correlations between radiographic and MRI measures were assessed with Pearson correlation and Bland-Altman plot analyses. The Youden J index was used to select optimum cutoff points for each parameter. RESULTS There were 30 patients (44 hip joints; mean age, 54.8 ± 11 years) in the ischiofemoral impingement group and 88 patients (88 hip joints; mean age, 51.8 ± 13.4 years) in the control group. There were significant group differences in ischiofemoral space, quadratus femoris space, ischiofemoral distance on supine radiograph, ischiofemoral distance on standing radiograph, and neck-shaft angle (p < 0.05). Ischiofemoral distance on supine and standing radiographs exhibited good discriminative ability (AUC > 0.80). The optimal cutoff points for ischiofemoral distances on supine and standing radiographs were 19.9 and 19.1 mm for reader 1 and 21.1 and 17.0 mm for reader 2. Ischiofemoral space, quadratus femoris space, ischiofemoral distance on supine radiograph, and ischiofemoral distance on standing radiograph exhibited nearly perfect interobserver agreement (r > 0.8). CONCLUSION Ischiofemoral distances on supine and standing hip radiographs had good diagnostic performance and can be used as a screening tool, with optimal cutoff points.
Collapse
|
22
|
Hujazi I, Jones T, Johal S, Bearcroft P, Muniz-Terra G, Khanduja V. The normal ischiofemoral distance and its variations. J Hip Preserv Surg 2016; 3:197-202. [PMID: 27583158 PMCID: PMC5005057 DOI: 10.1093/jhps/hnw003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 11/25/2015] [Accepted: 01/11/2016] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to measure the ischiofemoral distance (IFD) in the normal hip with healthy surrounding soft tissues and describe its variations caused by gender, age and proximal femoral anatomy so that this could serve as a reference for future studies on this subject. This is a retrospective study in which we reviewed the CT scans of 149 patients (298 hips) who had a CT of their pelvis for non-orthopaedic (abdomino-pelvic) pathology. The images were reviewed by two independent observers and the IFD (the smallest distance between the lateral cortex of the ischial tuberosity and the posteromedial cortex of the lesser trochanter), offset (the perpendicular distance from the centre of the femoral head to a line running down the middle of the shaft of the femur) and the neck-shaft angle (the angle between the lines in the middle of the neck to the line forming the axis of the femoral shaft) were measured. The CT scans belonged to 71 males and 78 females (M: 48%, F: 52%), with an average age of 51 ± 19 years (range 18–92). The mean IFD was 18.6 ± 8 mm in the females and 23 ± 7 mm in the males and this difference was statistically significant (P < 0.001). The IFD increased by 1.06 mm for each 1 mm of offset and dropped by 0.09 mm with each year of age. However, the neck-shaft angle did not show any significant correlation with the IFD.
Collapse
Affiliation(s)
- I Hujazi
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| | - T Jones
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| | - S Johal
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| | - P Bearcroft
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| | - G Muniz-Terra
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| | - V Khanduja
- 1. Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hill Road, Cambridge CB2 0QQ, UK
| |
Collapse
|
23
|
Abstract
PURPOSE To show that quadratus femoris muscle partial or complete tear is an extremely rare if not underdiagnosed cause of hip pain. METHODS We present the case of a 75-year-old Caucasian woman with spontaneous non-traumatic quadratus femoris tear. RESULTS Computed Tomography showed quadratus femoris tear with occult underlying ischiofemoral impingement pathology. CONCLUSIONS Quadratus femoris muscle is a hip external rotator and adductor and is situated along the posterior aspect of the hip joint and its proximity of anatomy with other external rotators leads to diagnostic pitfalls for radiologists. Identification of the exact muscle tear will establish the diagnosis, guide the proper physical therapy and reliably inform the patient what to expect after treatment.
Collapse
|
24
|
Papoutsi D, Daniels J, Mistry A, Chandraseker C. Ischiofemoral impingement due to a lipoma of the ischiofemoral space. BMJ Case Rep 2016; 2016:bcr-2015-213210. [PMID: 26746832 DOI: 10.1136/bcr-2015-213210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-focal hip and groin pain can frequently be a diagnostic problem, particularly if it is related to uncommon causes such as ischiofemoral impingement. The vast majority of published cases of ischiofemoral impingement are caused by osseous changes of the ischiofemoral interval. We describe an unusual case of ischiofemoral impingement caused by an intermuscular lipoma. Surgical resection of the tumour and histology confirmed the lipomatous nature of the tumour, with subsequent resolution of symptoms. To the best of our knowledge, this is the first case of a lipoma causing ischiofemoral impingement described in the English literature and emphasises that impingement can occur on the basis of a soft tissue mass occupying the interval of otherwise normal osseous interval and boundaries.
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Abstract
Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. This clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors. J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829.
Collapse
|
27
|
Finnoff JT, Bond JR, Collins MS, Sellon JL, Hollman JH, Wempe MK, Smith J. Variability of the Ischiofemoral Space Relative to Femur Position: An Ultrasound Study. PM R 2015; 7:930-937. [PMID: 25772723 DOI: 10.1016/j.pmrj.2015.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ischiofemoral impingement is caused by compression of the quadratus femoris muscle between the ischial tuberosity and lesser trochanter. The evaluation of ischiofemoral impingement includes radiologic studies to evaluate the ischiofemoral space dimensions. No prior study has evaluated the effect of femoral position on ischiofemoral space dimensions. OBJECTIVE To determine whether the dimensions of the ischiofemoral space vary with changes in femoral position. DESIGN Cross-sectional study. SETTING Academic institution. PARTICIPANTS Six male and four female subjects with no hip pain and no history of hip disorders or surgery were selected to participate in the study. The subjects' mean age was 31.5 years; mean height, 176.8 cm; mean weight, 70.2 kg; and mean body mass index, 23.6 kg/m(2). METHODS Ultrasound was used to measure the ischiofemoral space in bilateral gluteal regions of each volunteer. The volunteers underwent imaging in a prone position. The ischiofemoral space was measured with the femur in 9 different positions created through various combinations of frontal (15° abduction, neutral, and 15° adduction) and transverse (30° internal rotation, neutral, and 30° external rotation) plane hip motions. MAIN OUTCOME MEASUREMENTS The narrowest ischiofemoral interval, defined as the narrowest distance between the medial cortex of the lesser trochanter and the lateral cortex of the ischial tuberosity. RESULTS The anatomic landmarks used to measure the ischiofemoral space were easily identified in all subjects. The frontal plane main effect (F2,18 = 38.611) was statistically significant (P < .001), as was the transverse plane main effect (F2,18 = 82.452, P < .001). These findings indicated that there was a statistically significant difference in ischiofemoral space according to hip position in the frontal and transverse planes. The largest ischiofemoral space measurement occurred with the hip in abduction and internal rotation (51.8 mm; 95% confidence interval [CI], 49.2-54.5 mm), whereas hip adduction and external rotation resulted in the narrowest ischiofemoral space measurement (30.8 mm; 95% CI, 25.5-36.0 mm). The largest difference was between the adduction-external rotation and the abduction-internal rotation positions (mean difference = 21.1 mm; 95% CI, 13.7-28.5 mm; P < .001), and the smallest difference was between the adducted-neutral rotation and the abducted-external rotation positions (mean difference = 0.23 mm; 95% CI, -8.07-8.55 mm; P = .99). CONCLUSIONS Femoral position affects ischiofemoral space dimensions. The ischiofemoral space widens with abduction and internal rotation and narrows with adduction and external rotation, and thus femoral position should be considered when imaging and measuring the ischiofemoral space.
Collapse
Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403; Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, CA
| | | | | | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Michael K Wempe
- Department of Physical Medicine & Rehabilitation, University of Minnesota, Minneapolis, MN
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403
| |
Collapse
|
28
|
Primary functions of the quadratus femoris and obturator externus muscles indicated from lengths and moment arms measured in mobilized cadavers. Clin Biomech (Bristol, Avon) 2015; 30:231-7. [PMID: 25697090 DOI: 10.1016/j.clinbiomech.2015.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The small muscles of the pelvis and hip are often implicated in painful conditions. Although the quadratus femoris and obturator externus are usually described as external rotators of the hip, little is known about how they change their lengths and moment arms during human movement. Therefore, more precise measurements defining the positions and directions for their maximal strength and stretch are needed to better describe their functions and guide the clinical approach to pain. METHODS Repeated measurements of the muscle lengths and range of motion were obtained using wires simulating dissected muscles on human cadaver hips. The lengths were measured at every 15° of flexion with and without maximal range of ab/adduction, rotation, and combinations of the two motions. Measurements were obtained from normal hips (n=3), and movement-lengthening relations were later differentiated into movement-moment arm relations. FINDINGS The quadratus femoris showed maximum lengthening by flexion, adduction or abduction, and internal rotation, with the largest moment arms observed for extension in the deduced force-length efficient range of 60-90° flexion. The obturator externus showed maximum lengthening by extension, abduction, and internal rotation, with the largest moment arms observed for flexion and adduction in the deduced force-length efficient range around the hip's neutral position. INTERPRETATION Our findings indicate that maximal strength of the quadratus femoris muscle will be delivered in a flexed position towards extension, while maximal strength of the obturator externus muscle will be delivered in an extended position towards flexion and adduction.
Collapse
|
29
|
Ischiofemoral impingement syndrome: Spectrum of MRI findings in comparison to normal subjects. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
30
|
|
31
|
|
32
|
|
33
|
Using proximal hamstring tendons as a landmark for ultrasound- and CT-guided injections of ischiofemoral impingement. Radiol Case Rep 2013; 8:789. [PMID: 27330616 PMCID: PMC4900207 DOI: 10.2484/rcr.v8i1.789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Ischiofemoral impingement has been reported in a number of cases as an association between hip pain and quadratus femoris MRI signal abnormality, with concurrent narrowing of the ischiofemoral space. While the literature has included much emphasis on the imaging characteristics useful in the diagnosis of this entity, information on treatment has been scant, with few case reports of surgical resection of the lesser trochanter and incomplete descriptions of steroid injection techniques. We report a case of ultrasound- and CT-guided steroid injection into the ischiofemoral space via the proximal hamstring tendons in a 57-year-old female who had imaging and clinical characteristics of ischiofemoral impingement. The technique is described as a safe alternative to other possible injection techniques.
Collapse
|
34
|
Viala P, Vanel D, Larbi A, Cyteval C, Laredo JD. Bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. Skeletal Radiol 2012; 41:1637-40. [PMID: 22865159 DOI: 10.1007/s00256-012-1488-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/01/2012] [Accepted: 07/02/2012] [Indexed: 02/02/2023]
Abstract
The skeletal anatomy of the hip provides two main locations for impingement: abnormal contact between the acetabulum and femur (femoroacetabular impingement) or between the ischium and femur (ischiofemoral impingement). We report a case of bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. The association of exostoses and femoral metaphyseal widening resulted in the narrowing of the ischiofemoral spaces. Pain was improved on the left side by resection of the ischial exostosis.
Collapse
Affiliation(s)
- Pierre Viala
- Department of Radiology, Lapeyronie Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, Cedex 5, France.
| | | | | | | | | |
Collapse
|
35
|
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]
|
36
|
Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J 2012; 8:213-24. [PMID: 24082863 PMCID: PMC3470663 DOI: 10.1007/s11420-012-9304-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. QUESTIONS/PURPOSES The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis? METHODS An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations. RESULTS An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment. CONCLUSIONS A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.
Collapse
Affiliation(s)
- Lazaros A. Poultsides
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Asheesh Bedi
- Sports Medicine and Shoulder Surgery, MedSport, University of Michigan Health System, Ann Arbor, MI 48109 USA
| | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| |
Collapse
|
37
|
López-Sánchez MC, Armesto Pérez V, Montero Furelos LÁ, Vázquez-Rodríguez TR, Calvo Arrojo G, Díaz Román TM. Ischiofemoral impingement: hip pain of infrequent cause. ACTA ACUST UNITED AC 2012; 9:186-7. [PMID: 23017777 DOI: 10.1016/j.reuma.2012.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/01/2012] [Accepted: 06/05/2012] [Indexed: 10/26/2022]
Abstract
Hip pain is a frequent cause of medical attention in the daily clinical practice. Among the different causes included in the differential diagnosis we find ischiofemoral impingement, described initially in patients after joint replacement surgery, but later found in patients with no history of a causal disease.
Collapse
|
38
|
|
39
|
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. . .
| |
Collapse
|
40
|
Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R. Imaging of snapping phenomena. Br J Radiol 2012; 85:1343-53. [PMID: 22744321 DOI: 10.1259/bjr/52009417] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Snapping phenomena result from the sudden impingement between anatomical and/or heterotopical structures with subsequent abrupt movement and noise. Snaps are variously perceived by patients, from mild discomfort to significant pain requiring surgical management. Identifying the precise cause of snaps may be challenging when no abnormality is encountered on routinely performed static examinations. In this regard, dynamic imaging techniques have been developed over time, with various degrees of success. This review encompasses the main features of each imaging technique and proposes an overview of the main snapping phenomena in the musculoskeletal system.
Collapse
Affiliation(s)
- R Guillin
- Department of Musculoskeletal Imaging, Rennes University Hospital, CHU de Rennes, Rennes, France.
| | | | | | | | | |
Collapse
|
41
|
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; 41:575-87. [PMID: 21874607 DOI: 10.1007/s00256-011-1257-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/09/2011] [Accepted: 08/12/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to describe the magnetic resonance imaging (MRI) findings in patients with ischiofemoral impingement (IFI) and to evaluate the reliability of these MRI findings. MATERIALS AND METHODS Seventy hips of 50 patients with hip pain and quadratus femoris muscle (QFM) edema and 38 hips of 30 control cases were included in the study. The QFM edema and fatty replacement were assessed visually. Ischiofemoral space (IFS), quadratus femoris space (QFS), inclination angle (IA), hamstring tendon area (HTA), and total quadratus femoris muscle volume (TQFMV) measurements were performed independently by two musculoskeletal radiologists. The intra- and interobserver reliabilities were obtained for quantitative variables. RESULTS IFS, QFS, and TQFMV values of the patient group were significantly lower than those of controls (P < 0.001). HTA and IA measurements of the patient group were also significantly higher than in controls (P < 0.05). The QFM fatty replacement grades were significantly higher in the patient group than in the control group (P < 0.001). Inter- and intra-observer reliabilities were strong for all continuous variables. CONCLUSION Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.
Collapse
Affiliation(s)
- Ozgur Tosun
- Department of Radiology, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Abstract
Femoroacetabular impingement is a well-documented cause of hip pain. There is, however, increasing evidence for the presence of a previously unrecognised impingement-type condition around the hip - ischiofemoral impingement. This is caused by abnormal contact between the lesser trochanter of the femur and the ischium, and presents as atypical groin and/or posterior buttock pain. The symptoms are gradual in onset and may be similar to those of iliopsoas tendonitis, hamstring injury or bursitis. The presence of ischiofemoral impingement may be indicated by pain caused by a combination of hip extension, adduction and external rotation. Magnetic resonance imaging demonstrates inflammation and oedema in the ischiofemoral space and quadratus femoris, and is distinct from an acute tear. To date this has only appeared in the specialist orthopaedic literature as a problem that has developed after total hip replacement, not in the unreplaced joint.
Collapse
Affiliation(s)
- G H Stafford
- The Richard Villar Practice, Spire Cambridge Lea Hospital, 30 New Road, Impington, Cambridge CB24 9EL, UK.
| | | |
Collapse
|
44
|
Abstract
Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions. Pincer impingement generally involves the acetabular side of the joint where there is excessive coverage of the acetabulum, which may be focal or more diffuse. There is linear contact of the acetabulum with the head/neck junction. Cam impingement involves the femoral head side of the joint where the head is associated with bony excrescences and is aspheric. The aspheric femoral head jams into the acetabulum. Imaging appearances are reviewed below. This type is evident in young males in the second and third decades. The main features of FAI are described.
Collapse
|
45
|
MRI of the Quadratus Femoris Muscle: Anatomic Considerations and Pathologic Lesions. AJR Am J Roentgenol 2011; 197:170-4. [DOI: 10.2214/ajr.10.5898] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
46
|
Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skeletal Radiol 2011; 40:653-6. [PMID: 21207021 DOI: 10.1007/s00256-010-1085-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 12/10/2010] [Accepted: 12/13/2010] [Indexed: 02/02/2023]
Abstract
An association between hip pain and quadratus femoris MRI abnormality with concurrent narrowing of the ischiofemoral space has been reported in a number of patients to date, raising the possibility that the muscular damage observed is due to ischiofemoral impingement. Possible impingement has been noted primarily in middle-aged females either with or without a history of trauma or surgery, and associated snapping of the hip is a rarely described feature. We report here on a 17-year-old girl who presented with post-traumatic hip pain; she later developed evidence of ischiofemoral narrowing and quadratus femoris edema on MRI in addition to an audible snapping. Surgical resection of the lesser trochanter was performed, relieving both her hip pain and the snapping. To our knowledge, this is the first reported case of non-iatrogenic ischiofemoral impingement with surgical confirmation. The diagnosis of ischiofemoral impingement should be considered in patients complaining of a snapping hip.
Collapse
Affiliation(s)
- Adam Mohsan Ali
- Nuffield Orthopaedic Centre Department of Radiology, University of Oxford, Oxford, UK
| | | | | |
Collapse
|
47
|
Llopis E, Higueras V, Vaño M, Altónaga JR. Anatomic and radiographic evaluation of the hip. Eur J Radiol 2011; 81:3727-36. [PMID: 21470809 DOI: 10.1016/j.ejrad.2011.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 03/07/2011] [Indexed: 11/25/2022]
Abstract
The hip is a challenging joint to study is deeply located in the pelvis and surrounding by a large group of muscles with complex tendinous attachments. Our knowledge has recently increased together with the advent of new surgical techniques but further research is needed to better understand hip biomechanics and the relevance of some of radiological findings. Although recent techniques such as MR show anatomy exquisitely is essential to start with pelvis plain radiography for a good evaluation of bone structures and pelvis alignment. During this chapter we will be give a short overview of pelvis normal structures and some key points of MR and MR arthrography technique, because more detailed description is done on every specific chapter.
Collapse
Affiliation(s)
- Eva Llopis
- Hospital de la Ribera, Carretera de Corbera km1, Alzira 46600, Valencia, Spain.
| | | | | | | |
Collapse
|
48
|
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.
Collapse
Affiliation(s)
- Tanja Miokovic
- Centre for Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | |
Collapse
|
49
|
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.
Collapse
Affiliation(s)
- Artan Bano
- Department of Orthopaedic and Traumatology, University Hospital of Heraklion, 71110, Crete, Greece.
| | | | | | | | | | | |
Collapse
|
50
|
|