Learning objectives
Discuss the importance of correlation between clinical and imaging findings in ischiofemoral impingement (IFI)
Demonstrate the conventional radiograph, ultrasound (US) and magnetic resonance imaging (MRI) findings in IFI in children
Discuss the role of US-guided injection procedures in diagnosing and treating IFI
Background
IFI has rarely been described in children. It is defined as impingement of the quadratus femoris muscle (QFM) due to narrowing of the ischiofemoral space (IFS) and quadratus femoris space (QFS). IFS is defined as the smallest distance between the ischial tuberosity (IT) and lesser trochanter (LT). QFS is defined as the smallest space for the passage of the QFM bordered by the hamstring tendons and the iliopsoas tendon or LT. Fig. 1 IFS/QFS normally increases in size with age.
IFI is often misdiagnosed due...
Findings and procedure details
ETIOLOGY
The risk factors arepostural (extension, adduction, and external rotation of the hip), congenital (female pelvis, coxa valga and profunda, hip dysplasia) and acquired (hereditary multiple exostoses, solitary osteochondromas, psoas or hamstring avulsion injuries, tumors, Legg–Calve–Perthes disease).
CLINICAL FINDINGS
Children most often present with limping due to non-specific hip, groin and/or buttock pain with the typical aggravating hip movements of extension, adduction, and external rotation. The pain can radiate along the posterior thigh, because of irritation of the sciatic nerve. A snapping or locking sensation...
Conclusion
IFI is still frequently misdiagnosed or neglected because of its rarity, and the absence of specific clinical findings and diagnostic tests. Imaging with clinical correlation is the key for solving it this diagnostic challenge.
Personal information and conflict of interest
T. Hebar; Maribor/SI - Author at University Medical Centre Maribor, Slovenia M. Kljaic Dujic; Maribor/SI - Author at University Medical Centre Maribor, Slovenia M. Rupreht; Maribor/SI - Author at University Medical Centre Maribor, Slovenia N. Hanžič; Maribor/SI - Author at University Medical Centre Maribor, Slovenia
References
Dong C, Nowakowski AM, Kreig AH. Bilateral ischiofemoral im- pingement: a case report and literature review. J Ortho Bone Disord. 2017;1(4):0000120.
Duque Orzco MDP, Abousamra O, Rogers KJ, Thacker MM (2018) Magnetic Resonance Imaging in Symptomatic Children With Hereditary Multiple Exostoses of the Hip. J Pediatr Orthop. 38(2): 116-121.
Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA (2009) Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. American journal of roentgenology. 193(1): 186-190.
Tosun O, Algin O,...
