Ischiofemoral Impingement Syndrome
A 48-year-old female patient visited the hospital due to a left hip pain, radiating to the lower extremity with a hip snapping sensation for 2 months, especially on walking. There was no symptom on the right side. She was able to walk independently and bear weight on the affected side, but complained of more pain on the weight bearing status. She had no history of lower extremity trauma or surgery except hypertension due to primary aldosteronoma. In physical examination, a range of motion of the hip internal and external rotation was decreased slightly without pain. She had strong palpable deep peroneal artery and audible digital artery flow bilaterally. There was no motor weakness, but there was a sensory change on the lateral aspect of the leg and dorsum of foot, compatible with the L5 dermatomal area. She had normal deep tendon reflex bilaterally on knee jerk and ankle jerk. Babinski sign and ankle clonus were absent. Straight leg raising test was decreased to 30 degrees only on the left side. Lasegue test and Patrick sign were positive on the left side, but negative on the right side.\nWe requested radiographs and MRI of the lumbar spine for further evaluation. MRI of the spine showed no abnormality except diffuse and mild bulging disc without cord compression at the lumbosacral area. The radiographs of pelvis in anteroposterior and frog lateral projection showed no abnormal finding. Electrophysiologic study showed normal findings. There were no abnormal results compatible to the lumbosacral radiculopathy or spinal stenosis. At last, MRI of the hip was performed. Hip MRI revealed bilaterally increased signal intensity of the quadratus femoris muscle with concurrent narrowing of the ischiofemoral space. On axial T2-weighted fat-suppressed magnetic resonance images (), there were diffuse edema and increased signal intensity within the quadratus femoris muscle bilaterally. The distance of ischiofemoral space was 12.96 mm on the right side and 10.24 mm on the left side. The distance of quadratus femoris space was 6.17 mm on the right side and 4.31 mm on the left side (). There were no abnormal findings, such as degenerative arthritis, femoroacetabular impingement, or osteonecrosis, as possible causes of other hip pain origins. It was compatible with ischiofemoral impingement syndrome bilaterally. She complained the hip pain only on the left side, not the right side.\nAfter being diagnosed with the ischiofemoral impingement syndrome, the patient was hospitalized for a treatment over four weeks. Nonsteroidal anti-inflammatory drugs and gabapentin were prescribed for pain relief. Hot pack, ultrasound, and interferential current therapies were applied around the hip area. She received an exercise program for stretching of the hip muscle and connective tissues. The exercise program was targeted to the quadriceps femoris, piriformis, and other hip muscles, in order to adequately reduce pain and increase the range of motion in the hip joint. After discharge, the patient maintained the drug regimen and exercise program. The initial visual analogue scale (VAS) was 7 to 8. After six weeks of treatment, pain of the left hip was decreased gradually to VAS 2 to 3. The range of motion in the hip joint was normalized, and the hip snapping sensation was resolved.