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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original
Contribution / Clinical Investigation
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<-- Kuwait -->
Hyperglycemia
In Pregnancy in Arab Population, Kuwait Oil
Company Hospital, Kuwait
[pdf
version]
Hany M. Aiash, Sameh F. Ahmed,
Amro Abo Elezz
<-- Jordan -->
Ischiofemoral
impingement syndrome , incidence and clinical
importance
[pdf
version]
Jamil S. Shawaqfeh, Maysoon Banihani, Hend Harahsheh,
Ashraf Tamimi,
Abdulaziz Bawazir
<-- Abu Dhabi -->
Assessment
of behaviors, risk factors of Diabetic foot
ulcer and footwear safety among diabetic patients
in primary care setting, Abu Dhabi, UAE
[pdf version]
Osama Moheb Ibrahim Mohamed, Nwanneka E. O.
Ofiaeli, Adnan Syeed, Amira Elhassan,
Mona Al Tunaiji, Khuloud Al Hammadi, Maryam
Al Ali
<-- Nepal -->
Determinants
and Prevalence of Stunting Among Rural Kavreli
Pre-school Children
[pdf
version]
Kharel Sushil, Mainalee Mandira, Pandey Niraj
DOI:
<-- Qatar -->
Medical
and Psychological Associations with Nocturnal
Enuresis in Children in Qatar
[pdf version]
Ahmed Mohamed Kahlout, Hayam Ali AlSada
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International Health
Affairs
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<-- Turkey -->
Aging
Syndrome
[pdf
version]
Mehmet Rami Helvaci, Orhan Ayyildiz, Orhan Ekrem
Muftuoglu, Mustafa Yaprak
Abdulrazak Abyad, Lesley Pocock
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Chief
Editor -
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Abyad
MD, MPH, MBA, AGSF, AFCHSE
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| April/May 2017
- Volume 15, Issue 3 |
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Ischiofemoral impingement
syndrome , incidence and clinical importance
Jamil S.
Shawaqfeh
Maysoon Banihani
Hend Harahsheh
Ashraf Tamimi
Abdulaziz Bawazir
Radiologists
Royal Medical Services
Jordan
Correspondence:
Jamil
. S . Shawaqfeh , MD
Royal Medical Services
Jordan
Email: jshawaqfeh@yahoo.com
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Abstract
Objective: To evaluate the incidence
of ischiofemoral impingement (IFI) syndrome
among patients who presented for pelvic
MRI as a case of pelvic pain at KHMC.
Methods: 125 pelvic MRI were done
between August 2015 and August 2016 ,
for patients who presented as cases of
LBP or pelvic pain at KHMC and were reviewed.
All studies were done on a Skyra 3 Tesla
MRI machine with standard protocol of
coronal STIR images , axial T1 and T2WI
and PD fat sat sequences.
The studies were reviewed for quadratus
femoris muscle edema or atrophy and measurements
of both quadratus femoris and ischiofemoral
spaces were done. Results were analyzed
using simple statistical methods.
Results:
7 patients of the 125 had the full blown
picture of IFI syndrome accounting for
around 5 % of patients.
2 of them had long standing unexplained
pelvic pain.
5 of them had the changes after history
of pelvic surgery or trauma.
Conclusion: Ischiofemoral impingement
syndrome should be considered in the differential
diagnosis of patients with LBP, hip pain
or unexplained pelvic pain especially
in patients with history of pelvic surgery
or trauma.
Key words: Ischiofemoral, impingement,
pelvic
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Ischiofemoral impingement syndrome is a clinical
entity, meaning that there is narrowing of the
space between the ischial bone and the lesser
trochanter of the femur impinging upon the quadratus
femoris muscle.
MRI is a widely accepted and used method for
evaluation of patients with low back pain and
pelvic pain and it is usually ordered looking
for common causes of these pains including disc
diseases , joint problems , inflammatory arthritis
or many conditions with the same clinical presentation.
Of these conditions radiologists noticed a clinical
entity in which there is edema in quadratus
femoris muscle . This muscle has a course between
the lesser trochanter of the femur and the ischial
spine.
They began to do measurements for this space
and found it to be around 20 mm on average.
Another important space to measure is called
the quadratus femoris space measured between
the insertion of the iliopsoas muscle and the
insertion of hamstring muscle.
When these spaces are narrow, impingement of
the quadratus femoris muscle with edema and
later on atrophy, is noticed.
This was described as ischiofemoral impingement
syndrome.
This entity has more prevalance in patients
who had previous pelvic surgery or trauma.
The purpose of this study was to evaluate the
incidence of ischiofemoral impingement (IFI)
syndrome among patients who presented for pelvic
MRI as a case of pelvic pain at KHMC.
125
pelvic
MRI
were
done
between
August
2015
and
August
2016
,
for
patients
who
presented
as
cases
of
LBP
or
pelvic
pain
at
KHMC
and
were
reviewed.
All
studies
were
done
on
Skyra
3
Tesla
MRI
machine
with
standard
protocol
of
coronal
STIR
images
,
axial
T1
and
T2WI
and
PD
fat
sat
sequences.
The
studies
were
reviewed
for
quadratus
femoris
muscle
edema
or
atrophy
and
measurements
of
both
quadratus
femoris
and
ischiofemoral
spaces
were
done.
Results
were
analyzed
using
simple
statistical
methods.
The
measurements
were
done
to
evaluate
both
the
ischiofemoral
space
which
is
the
narrowest
space
between
the
cortex
of
ischial
spine
to
the
cortex
of
the
lesser
femoral
trochanter
,
and
the
quadratus
femoris
space
which
is
the
narrowest
space
between
the
superolateral
surface
of
hamstring
muscle
and
the
posteromedial
surface
of
iliopsoas
muscle.
The
spaces
were
measured
by
three
radiologists
in
three
separate
settings
and
the
results
were
averaged.
Also,
the
changes
in
signal
intensity
of
the
quadratus
muscle
were
evaluated
for
edema,
muscle
injury
or
atrophy.
7
patients
of
the
125
had
the
full
blown
picture
of
IFI
syndrome
accounting
for
around
5
%
of
patients.
2
of
them
had
long
standing
unexplained
pelvic
pain.
5
of
them
had
the
changes
after
history
of
pelvic
surgery
or
trauma;
three
of
these
had
previous
MRI
studies
with
nearly
normal
IFS
and
QFS
and
the
narrowing
occuring
after
the
pelvic
surgery.
The
average
measurement
for
the
IFS
was
around
19
mm.
The
average
measurement
of
the
QFS
was
around
16
mm.
The
changes
involving
the
quadratus
femoris
muscle
include
edema,
muscle
tear
and
atrophic
changes.
The
complex
anatomy
of
the
pelvis
provides
a
potential
space
for
impingement
between
the
lesser
trochanter
of
the
femur
and
the
ischium.
This
space
is
subject
affected
by
the
anatomy
of
the
pelvis
and
the
natural
support
mechanisms
so
any
disruption
to
the
normal
anatomy
may
affect
this
space
such
as
in
cases
of
bony
pelvic
surgeries
or
trauma.
The
clinical
presentation
most
of
the
time
is
hip
pain
with
radiation
to
the
lower
limbs;
the
pain
is
more
upon
standing.
The
pain
can
be
elicited
by
variable
hip
motions
mostly
if
you
combine
extension,
adduction
and
external
rotation
at
the
level
of
hip
joint
the
patient
will
feel
snapping
pain
with
radiation
to
the
lower
limbs.
In
this
study
the
average
in
IFS
was
around
19
mm
with
no
significant
gender
differences.
The
average
measurement
of
the
QFS
was
around
16
mm.
Other
similar
studies
show
nearly
similar
findings
indicating
no
definite
racial
differences.
In
patients
with
no
IFI
the
results
were
nearly
the
same
in
both
sides.
The
changes
in
the
QF
muscle
range
from
muscle
edema
to
muscle
wasting
in
chronic
cases.
5
of
the
seven
cases
who
had
changes
of
IFI
syndrome
had
these
changes
following
bony
pelvis
surgeries;
one
of
them
for
Ewing's
sarcoma
of
the
iliac
bone,
two
after
hip
arthroplasty
and
two
after
major
pelvic
trauma
with
variable
fractures.
We
aim
in
this
study
to
increase
the
level
of
awareness
about
this
important
clinical
entity.
Ischiofemoral
impingement
syndrome
should
be
considered
in
the
differential
diagnosis
of
patients
with
LBP,
hip
pain
or
unexplained
pelvic
pain,
especially
in
patients
with
a
history
of
pelvic
surgery
or
trauma.
1-
Ischiofemoral
impingement
syndrome;
American
journal
of
roentgenology
.
2009;193:
186-190
2-
Seyoung
lee
et
al,
Ischiofemoral
impingement
syndrome;
Ann
rehabil
med
,
vol
37,
feb
2013
3-
Piotr
palczewski,
Ischiofemoral
impingement
syndrome,
case
report,
Pol
journal
of
radiology
2015
,
80
,
496-498
4-
Sameh
Khdair
et
al,
Ischiofemoral
impingement
syndrome,
spectrum
of
MRI
findings
in
comparison
to
normal
subjects,
Vol
45
issue
3
sep
2014
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