yoga book / pathologie / Ischiofemorales Impingement (IFI)
Contents
Definition
Ischiofemoral impingement is a rather rare and not yet widely recognised dorsal external impingement of the hip joint, in which the trochanter minor rarely impinges on the sitz bone or rather pinches the quadratus femoris located there or impinges on the semimembranosus origin. It was first described in 1977 by Johnson as a complaint following hip TJA replacement. There may also be ischialgiform pain when the sciatic nerve is pinched in the space between the trochanter minor and the sitz bone. The pain is felt during walking towards the end of the support leg phase when the minor trochanter passes the sitz bone. Differentially relevant entities, which can also occur as comorbidities, such as PHT and DGS must be excluded or treated before therapy. The symptoms occur bilaterally in 25-40% of cases and are more common in females. The average distance from the lesser trochanter to the ischium is given as W: 18.6 mm and M: 23 mm.
In addition to the IFI, there are four other external impingements of the hip joint:
- DGS
- subspinal impingement (SIAI-impingement) in hip flexion: Between enlarged or malformed SIAI (spina iliaca anterior inferior) and distal anterior femoral neck. The rectus femoris (caput rectum), the iliocapsularis and the ventral joint capsule may be compressed. In addition to the malformation of the SIAI, there may be other underlying causes:
– acetabular correction osteotomies
– hypertrophic ossifications following distally mishealed avulsions (sprinter fracture)
– strain-induced traction osteophytes at ventral joint capsule and iliofemoral ligament. iliofemoral.
The possibility of subspinous impingement was first suggested by Pan et al. in 2008, and in 2011 Larson et al. introduced this term and described arthroscopic decompression in three athletes. Hetseroni et al. published from 2012 onwards. Predisposing factors are retroversion of the acetabulum and increased anterior pelvic tilt with hyperlordosis. Pain is triggered by hip flexion, especially when the rotation changes. An internal impingement often accompanies the SIAS-impingement. - Iliopsoas impingement: Between the tendon of the iliopsoas and anterior labrum acetabulare, presumably due to a thickened iliopsoas tendon caused by trauma and subsequent impingement on the ventral capsule-labrum complex. Trigger: hip extension. Hip flexion can be painful, hip extension can cause snapping, especially when transitioning from flexion-abduction-exorotation to neutral position. Chronic iliopsoas impingement can damage the anterior labrum. In the case of coxarthrosis, acetabular rim osteophytes can exacerbate the symptoms.
- pectineofoveal impingement in the course of the pectineus in the area of the fovea capitis femoris between the medial plica synovialis (synovial membrane) and the zona orbicularis (annular ligament) due to a thickened plica or a synovial cyst
Cause
- Congenital or acquired changes in bone shape
Predisposing
- Steep femoral neck angle
- Increased antetorsion of the femur
- Far proximal attachment of the hamstrings (especially semimembranosus)
Diagnose
- MRI shows reduced distance of the trochanter minor to the sitz bone, change in the quadratus femoris (oedema), concern of the origin of the semimembranosus, concern of the tendon of the iliopsoas
- Tests and signs: Ischiofemoral impingement test
Symtome
- Muscular compression pain, especially with adduction-extension-exorotation, which is described as groin pain or gluteal pain, possibly with radiation to medial and towards the knee
- In severe cases: ischialgiform pain
Complications
Therapie
- Only if conservative therapy fails (less than 5%): repositioning osteotomy (intertrochanteric varisation)
- Conservative until further notice with avoidance of triggers, NSAIDs if necessary