Case Report
IIschiofemoral Impingement: Hip Pain of Infrequent Cause
Pinzamiento isquiofemoral: dolor de cadera de causa poco frecuente
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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2013;9:186-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 52773 "formatos" => array:3 [ "EPUB" => 160 "HTML" => 47292 "PDF" => 5321 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Pinzamiento isquiofemoral: dolor de cadera de causa poco frecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "186" "paginaFinal" => "187" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ischiofemoral impingement: Hip pain of infrequent cause" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 718 "Ancho" => 2335 "Tamanyo" => 129654 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A) Axial T1: pinzamiento de los espacios isquiofemoral (flecha gruesa) y cuadrado femoral (asterisco). 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(B) Axial T2 fat suppression signal: edema in both femoral muscles.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hip pain is a common cause of medical attention and diagnosis is difficult because the etiology is diverse.</p><p id="par0010" class="elsevierStylePara elsevierViewall">One of them, little known, is ischiofemoral impingement syndrome, first described in women after joint replacement surgery<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but subsequently described in patients with no history of disease.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 16-year-old casual athlete, with no known allergies or medical-surgical history of interest, consulting for hip pain over a year in development, located in the anterolateral aspect of the right hip and radiating to the anterior aspect of the knee, intervening with physical activity. The pain increased over time to preclude sports activity, except for short periods.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On physical examination the patient showed good general condition, without atrophy or deformities, and preserved mobility of the 4 limbs. There was snapping and production of pain with adduction, external rotation and extension.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Plain radiography of the lumbar spine and hips showed no abnormalities. Lab tests, including complete blood count, kidney and liver function, calcium, phosphorus, alkaline phosphatase, CPK, thyroid hormones, and autoimmunity tests, as well as acute phase reactants, were within normal parameters.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the clinical persistence we requested an MRI of the hip, which displayed a reduced space between the lesser trochanter and the ischial tuberosity bilaterally, with increased compression and T2 signal in both femoral muscles translating intramuscular edema. The distance ischiofemoral space measurement obtained was 9<span class="elsevierStyleHsp" style=""></span>mm bilaterally and 5<span class="elsevierStyleHsp" style=""></span>mm wide on the right femoral space and 6<span class="elsevierStyleHsp" style=""></span>mm on the left (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). No FAI data was obtained.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Based on these findings, a diagnosis of ischiofemoral impingement syndrome was made and treated with NSAIDs, analgesics and rest, with progressive reintroduction of sports activities, showing marked improvement.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The pelvic bone anatomy provides two possible points of impingement. Impingement is a condition known and widely described, but the space between the lesser trochanter and the ischium is usually not considered, since it is wider between these structures.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ischiofemoral impingement syndrome was first described in patients with persistent hip pain after hip<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> replacement. The distance between the ischium and the lesser trochanter was reduced after surgery in these patients, while others, such as those with intertrochanteric fracture, pelvic corrective valgus osteotomy or hip degenerative arthritis, superomedial migration of the femur, subsequently impinged.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The concept of ischiofemoral impingement in patients without previous injury was recently described.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The prevalence is unknown, since we have only small series of cases. Affected patients are typically women, suggesting a potential link between the female pelvic anatomical arrangement, with prominent and separated ischial tuberosities.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It develops clinically from months to years, with pain anteriorly and medial to the hip, sometimes radiating to the lower extremity. Involvement is bilateral in one quarter of patients.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In those patients in whom there is clinical suspicion, plain light hip adduction, external rotation (unlike the study performed conventionally) and extension could potentially be helpful in some cases, with a normal value of the ischiofemoral space being 2<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Diagnosis, however, is established through magnetic resonance. Characteristic findings are a decreased ischiofemoral space compared to healthy controls (ischiofemoral space of 23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>mm and femoral space of 12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm)<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and altered signals from the femoral muscle, which results in edema of the myotendinous junction or intramuscular rupture. If involvement is prolonged the clinical course is chronic, there may be muscle atrophy and muscle bundle replacement by fibrofatty tissue. Sometimes it can affect the insertion of the hamstrings and, to a lesser extent, the ilio-psoas, which was not observed in our case.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The differential diagnosis is made with those conditions involving groin pain, and by discarding tendinitis, bursitis, osteitis or siphysitis, among others.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There is no optimal treatment with rest, use of analgesics and anti-inflammatory drugs or local injections having been used irregularly<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> but successfully. Surgical treatment offers a definitive clinical relief by resection of the lesser trochanter.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects.</span> The authors declare that no experiments were performed on humans or animals for this investigation.</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data.</span> The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent.</span> The authors have obtained the informed consent of the patients and /or subjects mentioned in the article. The author for correspondence is in possession of this document.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Disclosures</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres243419" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec230002" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres243420" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec230001" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Disclosures" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-27" "fechaAceptado" => "2012-06-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec230002" "palabras" => array:3 [ 0 => "Hip" 1 => "Ischiofemoral impingement" 2 => "Magnetic Resonance" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec230001" "palabras" => array:3 [ 0 => "Cadera" 1 => "Pinzamiento isquiofemoral" 2 => "Resonancia magnética" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El dolor de cadera es una causa frecuente de consulta médica en la clínica diaria. Entre las diferentes causas que entran en el diagnóstico diferencial está el síndrome de pinzamiento isquiofemoral, que se describió inicialmente en pacientes tras cirugía de recambio articular, pero que a posteriori se ha descrito en pacientes sin antecedente de patología causal.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please, cite this article as: López-Sánchez MC, et al. Pinzamiento isquiofemoral: dolor de cadera de causa poco frecuente. Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.06.005">http://dx.doi.org/10.1016/j.reuma.2012.06.005</span></p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 727 "Ancho" => 2335 "Tamanyo" => 119866 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Axial T1: impingement of the ischiofemoral spaces (thick arrow) and quadratus femoris (asterisk). (B) Axial T2 fat suppression signal: edema in both femoral muscles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty: report of three cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.A. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "The Journal of Bone and Joint Surgery. American Volume" "fecha" => "1977" "volumen" => "59-A" "paginaInicial" => "268" "paginaFinal" => "269" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI of quadratus femoris muscle tear: another cause of hip pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. O’Brien" 1 => "L.T. Bui-Mansfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.07.2408" "Revista" => array:6 [ "tituloSerie" => "American Journal of Roentgenology" "fecha" => "2007" "volumen" => "189" "paginaInicial" => "1185" "paginaFinal" => "1189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17954659" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impingement of lesser trochanter on ischium as a potencial cause for hip pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.W. Patti" 1 => "H. Ouellette" 2 => "M.A. Bredella" 3 => "M. Torriani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiology" "fecha" => "2008" "volumen" => "37" "paginaInicial" => "268" "paginaFinal" => "269" "itemHostRev" => array:3 [ "pii" => "S0140673608601075" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Signal abnormalities in the quadratu femoris muscle: tear or impingement?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Kassarjian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.07.3540" "Revista" => array:6 [ "tituloSerie" => "American Journal of Roentgenology" "fecha" => "2008" "volumen" => "190" "paginaInicial" => "W379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18492883" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356511003417" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Ali" 1 => "D. Whitwell" 2 => "S.J. Ostlere" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-010-1085-z" "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiology" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "653" "paginaFinal" => "656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21207021" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Torriani" 1 => "S.C. Souto" 2 => "B.J. Thomas" 3 => "H. 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Porte" 2 => "T.P. de Rooij" 3 => "A.C. de Vries" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "British Journal of Sports Medicine" "fecha" => "1997" "volumen" => "31" "paginaInicial" => "348" "paginaFinal" => "349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9429017" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356508004941" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischiofemoral impingement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.H. Stafford" 1 => "R.N. Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Journal of Bone and Joint Surgery. British Volume" "fecha" => "2011" "volumen" => "93" "paginaInicial" => "1300" "paginaFinal" => "1302" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000900000003/v1_201307311407/S217357431200158X/v1_201307311407/en/main.assets" "Apartado" => array:4 [ "identificador" => "17376" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000900000003/v1_201307311407/S217357431200158X/v1_201307311407/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431200158X?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
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| 2016 June | 0 | 16 | 16 |
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| 2016 March | 1 | 0 | 1 |
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| 2015 December | 2 | 0 | 2 |
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| 2015 October | 1 | 0 | 1 |
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| 2015 July | 109 | 6 | 115 |
| 2015 June | 157 | 22 | 179 |
| 2015 May | 182 | 20 | 202 |
| 2015 April | 234 | 23 | 257 |
| 2015 March | 250 | 10 | 260 |
| 2015 February | 226 | 12 | 238 |
| 2015 January | 191 | 18 | 209 |
| 2014 December | 196 | 14 | 210 |
| 2014 November | 186 | 10 | 196 |
| 2014 October | 177 | 12 | 189 |
| 2014 September | 188 | 20 | 208 |
| 2014 August | 218 | 20 | 238 |
| 2014 July | 211 | 23 | 234 |
| 2014 June | 254 | 17 | 271 |
| 2014 May | 234 | 24 | 258 |
| 2014 April | 201 | 17 | 218 |
| 2014 March | 204 | 26 | 230 |
| 2014 February | 164 | 13 | 177 |
| 2014 January | 157 | 14 | 171 |
| 2013 December | 133 | 11 | 144 |
| 2013 November | 142 | 11 | 153 |
| 2013 October | 120 | 17 | 137 |
| 2013 September | 106 | 15 | 121 |
| 2013 August | 87 | 25 | 112 |
| 2013 July | 75 | 18 | 93 |
| 2013 June | 76 | 37 | 113 |
| 2013 May | 16 | 9 | 25 |
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