Using proximal hamstring tendons as a landmark for ultrasound- and CT-guided injections of ischiofemoral impingement

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.

Treatment strategies for ischiofemoral impingement: a systematic review

“…On MRI, a marked narrowing of the ischiofemoral space with accompanying oedema of QF was seen. Initial conservative treatment was not successful Open resection of the exostosis was conducted The immediate post-operative recovery was uneventful Histological examination of the resection specimen confirmed the diagnosis of a benign cartilaginous exostosis Viala et al [ 39 ] 2012 France 4 0 1 1 6 months 37 37 The patient presented with hip pain of 2-year duration. Radiograph, CT, and MRI showed coxa valga and splaying of the intertrochanteric region and femoral neck as well as exostoses of the ischial tuberosity.…”

“…The overall quality of the eight articles was 80% based on the JBICAC ranging from 68.75 to 100% [ 3 , 11 , 21 – 23 , 37 , 39 , 41 ]. Four articles reported using conservative treatment (e.g.…”

“…activity restriction, intake of non-steroidal anti-inflammatory drugs (NSAIDs) or physiotherapy) [ 11 , 23 , 37 , 41 ]. Three articles reported the outcome following ultrasound (US) guided injection [ 21 , 22 , 39 ]. One article mentioned deploying prolotherapy with polydeoxyribonucleotide sodium mixed with the local anaesthetics under fluoroscopic and US guidance [ 3 ].…”

“…This mechanism of action was reported where Botox was used to treat chronic exertion compartment syndrome where pain faded and function improved [16]. [3] 100 Volokjina et al [40] 81.3 Kim et al [23] 87.5 Hayat et al [11] 75 Lee et al [24] 68.8 Yanagishita et al [41] 68.8 Tosun [38] 68.8 Mean 80 Open surgical treatment Papoutsi [31] 100 Schatteman [36] 62.5 Viala [39] 75 Ali [2] 75 Mean 78.1 Endoscopic surgical treatment…”

Ischiofemoral Impingement Syndrome: An Overview for Strength and Conditioning Professionals

“…Ischiofemoral impingement (IFI) occurs as a result of compression of the quadratus femoris (QF) muscle in the ischiofemoral space between the lesser trochanter and ischium (21). This rare type of hip injury is an overlooked cause of hip pain, being mostly described in single case studies (4,14,17,24,31,41,42) and reviews (26,35). It has been shown that a combination of hip adduction, extension, and external rotation provokes IFI pain sensations, with athletes who participate in sports using extension and external femur rotation, such as baseball, golf (25), or softball (16) being more prone to developing IFI.…”