Hip Conditions

Ischiofemoral Impingement

Ischiofemoral impingement syndrome occurs when the femoral bone impinges or impacts the ischium or sit bone.

Symptoms

  • Buttock pain
  • Hip Pain
  • Can feel similar to a pulled hamstring
  • Numbness and tingling down the leg, similar to sciatica type pain.
  • Stiffness in the hip

Causes

This typically is caused by an enlarged lesser trochanter. This is most often developmental but can also occur with trauma. Occasionally this can occur from the ischium bone. Because the two bones are so close, the soft tissue is pinched and causes pain. Tissue most frequently involved is the quadratus femoris muscle and the sciatic nerve. As the impacts get more frequent the pain gets worse and worse, the pain will also increase, and will usually limit activity over time. The pain is worse with extension of the hip (knee behind the body) similar to running or with longer strides.

Diagnosis and Tests

History and Physical Exam

To diagnose an ischiofemoral impingement, Dr Faucett will start with a physical exam. During the exam, Dr. Faucett will move your hip to replicate common impingement positions to see if this causes the same pain.

Imaging Studies

  • X-ray: Xrays of the pelvis and hip can show the relationship of the bones to see if there is impingement or a prominent lesser trochanter.
  • MRI: A MRI will also allow for more precise measurements of the ischiofemoral space and to determine if there is injury to the soft tissues such as the quadratus femoris or sciatic nerve.
  • CT: A CT exam will also help determine with more precision and detail the shape and relationship of the ischiofemoral space.
  • Nerve Study: An nerve study such as an EMG or NCS (electromyography or Nerve Conduction Study) can help determine if the sciatic nerve is being injured.

Treatments

There is no single strategy that is used to improve ischiofemoral impingement syndrome so may require trying multiple treatment options.

Activity Modification

Dr. Faucett usually initiates treatment with activity modification to limit your activities, especially ones that make your hips, buttocks, or groin hurt more.

Physical Therapy

Physical therapy will help you improve your symptoms by analyzing and modifying your gait during walking and running. Address the stiffness and muscle dysfunction associated with the condition. Can include other types of treatment including medical massage, manipulation, stretching, ultrasound, and dry needling.

Injections

Injection of anesthetics with or without cortisone can help diagnose the injury as well as provided some temporary improvement in the pain.

Surgical

If conservative measures do not help improve your condition, Dr. Faucett may recommend surgery to you.
The surgery would remove the prominence of the lesser trochanter but keep the psoas tendon (hip flexor), attached. This is performed using an endoscopic (arthoscopy) technique to burr down the bone. Other soft tissue procedures such as a piriformis release and debridement of the trochanteric bursa can also be performed at the same time as needed.

Risk Factors & Prevention

Ischiofemoral impingement itself is hard to prevent. Once diagnoses the pain and symptoms can be lessened by activity modification by taken shorter strides and avoiding the inciting activity.


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