Current concepts in the diagnosis and management of extra-articular hip impingement syndromes

Abstract

Purpose Extra-articular hip impingement syndromes encompass a group of conditions that have previously been an unrecognised source of pain in the hip and on occasion been associated with intra-articular hip impingement as well. As arthroscopic techniques for the hip continue to evolve, the importance of these conditions has been recognised recently and now form an important part of the differential of an individual presenting with hip pain. The aim of this article, therefore, is to provide the reader with an evidence-based and comprehensive update of these syndromes. Methods By reviewing past literature, the anatomy, pathophysiology, clinical features and the management of the five common extra-articular hip impingement syndromes were described. Results The common extra-articular impingement syndromes are: 1) Ischiofemoral impingement: quadratus femoris muscle becomes compressed between the lesser trochanter and the ischial tuberosity. 2) Subspine impingement: mechanical conflict occurs between an enlarged or malorientated anterior inferior iliac spine and the distal anterior femoral neck. 3) Iliopsoas impingement: mechanical conflict occurs between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology. 4) Deep gluteal syndrome: pain occurs in the buttock due to the entrapment of the sciatic nerve in the deep gluteal space. 5) Pectineofoveal impingement: pain occurs when the medial synovial fold impinges against overlying soft tissue, primarily the zona orbicularis. Knowledge for these syndromes still remains limited for reasons mostly relating to their low prevalence and their co-existence with typical femoro-acetabular impingement. Conclusions The knowledge of extra-articular hip impingement syndromes is essential and should form a part of the differential diagnoses alongside intra-articular pathology including femoro-acetabular impingement particularly in the younger patient with a non-arthritic hip.

Anatomical variation of the Psoas Valley: a scoping review

“…Vandenbussche et al reported that the depth of the psoas valley is approximately 4 mm from the acetabular equator [1,2], which is almost the same as the degree of superomedialization in the acetabula when reaming during a THR [20]. Therefore, pre-and intra-operative assessment of the psoas valley is essential to avoid postoperative iliopsoas impingement which is becoming a major issue following arthroplasty [21][22][23].…”

Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty

“…It is often difficult to determine the specific causes of groin pain [9]. Extra-articular subspine impingement at the level of the anterior inferior iliac spine (AIIS) has been reported as a cause of groin pain in the nonarthritic hip [10]. We describe a similar entity as a potential cause of refractive periarticular pain in the groin to the lateral hip region after THA: extra-articular impingement (EAI) between the AIIS and the anterior part of the GT.…”

Anatomical Variation of the Psoas Valley: A Scoping Review

“…As for other factors, Vandenbussche et al reported that the depth of the psoas valley is approximately 4 mm from the acetabular equator [1,2], which is almost the same as the degree of superomedialisation in the acetabulae when reaming during a THR [19]. Therefore, pre-and intra-operative assessment of the psoas valley is essential to avoid postoperative iliopsoas impingement which is becoming a major issue following arthroplasty [20][21][22].…”