Chronic ischio-femoral impingement

Case contributed by Dr Chris O'Donnell

Presentation

Severe posterior hip pain not relieved by physiotherapy or steroid injection into the hip joint.

Patient Data

Age: 50
Gender: Female
Modality: MRI

Narrowed ischio-femoral interspace to 7mm (ie between the ischial tuberoisty and lesser trochanter). The interposed quadratus femoris muscle shows focal increased T2 signal and attenuation of muscle fibres as compared with the reminder of the muscle that has a rather square appearance (best seen on the coronal) thus the anatomical name.  

Case Discussion

This is a classic case of ischio-femoral impingement with a narrowed channel through which the quadratus femoris is positioned.  The muscle acts to externally rotate and adduct the thigh which opens up this channel whereas internal rotation of the hip tends to reduce the space by bringing the lesser trochanter closer to the ischial tuberosity.  Note the channel is made even narrower by the additional hamstring tendon origins from the ischial tuberosity.

In this study the muscle is not only oedematous, but also attenuated on the PD axial image (just in the channel) indicating the chronicity of impingement.  This is not a neuropathic phenomenon as the whole muscle would be affected.

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Case Information

rID: 50732
Case created: 19th Jan 2017
Last edited: 21st Jan 2017
Inclusion in quiz mode: Included

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