Isquiofemoral Impingement

1. Ischiofemoral Impingement
Tratamento endoscopico por abordagem posterior do
pequeno trocanter
Jorge Cruz de Melo

2. The Porto Hip Unit
PHM2015

3. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
The hip has main bony sources for impingement
! Abnormal contact sites:
- acetabulum vs femur
- ischium vs femur
!

4. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Diminuição da distância
entre a tuberosidade
isquiática e o pequeno
trocanter
!

5. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Q: Quadratus femoris muscle
(QFM) is a flat muscle which
has a orgin on the Lateral margin
of the obturator ring above ischial
tuberosity and insertion on the
Quadrate tubercle and adjacent
bone of intertrochanteric crest of
proximal posterior femur.
IG: Inferior gemellus
OI: Obturator internius
SG: Superiorgemellus
P: Piriformis
SN: Sciaticnerve.
Q: Quadratus femoris
Lesser trochanter
I: Ischium tuberosity
H: Hamstrings tendon

6. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
nflito)isquiofemoral):"
moral"–"13mm"±"5mm""
ão"do"M."QF"
Torriani defined:
The ischiofemoral space (IFS)
as a gap between the ischium
tuberosity and the iliopsoas
tendon or the lesser trochanter.
The ischiofemoral space – 13mm ± 5mm
(23mm ± 8mm)
The quadratus femoris space
(QFS) as the smallest gap
between the superolateral
surface of the hamstring
tendons and the posteromedial
surface of the iliopsoas tendon
or the lesser trochanter.
The quadratus femoris space - 7 mm ± 3mm
(12mm ± 4mm)
Lesser trochanter
IschiumHamstrings
Tendeon
Quadratus femoris
muscle

7. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
MRI findings that shows reduced
IFS with edema and wasting of
quadratus femoris

8. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
1977
!
Johnson!KA.!

9. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2008
!
Kassarijan!A!

10. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2008
!
Patti J W

11. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2009
!
Torriani!M.!

12. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2011
!
Mohsan!A.!

13. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement

14. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Idiopatic
! Previous surgery, fracture or arthrosis iopatic
! Hamstrings tendinopathy
! Positional
! Coxa valga
Etiology

15. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Non focal groin or buttock pain
! Ischialgia with radiation to the medial thigh
! Painful popping, difficult to localize
! Often diagnosed as “snapping iliopsoas”
Clinical presentation

16. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
!
Diagnosis

17. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Diagnosis

18. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
• Rx e RM com alterações evidentes
• Clinica Evidente
• Rx e RM com alterações evidentes
• Clinica Duvidosa
• Rx e RM com alterações evidentes
• Sem Clinica
?
X
V

19. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Infiltracoes Diagnósticas/Terapeuticas
Ropivacaina 7.5 % 3 ml + Triancinolona 40 mg
Avaliar as primeiras 12 horas (1º dia)
Avaliar os 2º-3º dias
Avaliar 2 semanas depois

20. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Treatment
! To modify activity + NSAID
Active rest & to avoid provoking activities
! Fisioterapy
! Injections: diagnostic & therapeutic
! To widen ischiofemoral space

21. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Tratamento endoscopico por abordagem do pequeno trocanter

22. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! To widen ischiofemoral space
Tratamento endoscopico por abordagem do pequeno trocanter

23. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! To widen ischiofemoral space
Tratamento endoscopico por abordagem do pequeno trocanter
Lesser Trochanter
Lesser Trochanter
Iliopsoas
Iliopsoas
Posterior Aproach
Iliopsoas
Lesser Trochanter
Lesser Trochanter
Anterior Aproach

24. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Posteriot Aproach
Tratamento endoscopico por abordagem do pequeno trocanter
VIDEO

25. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Conclusion
Pre-op Pos-op

26. The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Ischiofemoral impingement could be the source of hip pain or ischialgia in women
! Idiopatic or acquired narrowing of the IFS could lead to edema and atrophy of the
QFM
! Not all patients with IF Impingement have narrowing of the IFS
! Not all IF space narrowing or QFM edema are symptomatic
! In doubt, the diagnosis could be confirmed by local infiltration
! The conservative measures with rest, activity restriction, NSAID’s, physical therapy
and steroid injection (image guided) may produce pain relief.
! Surgical treatment is reserved to patients in whom conservative treatment fails.
! The endoscopic posterior approach is a very good solution (parcial reception of the
leser trochanter and preservation of iliopsoas tendon)
Conclusion

27. The Porto Hip Unit
PHM2015
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