Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Orthopaedics
Published in: International Orthopaedics 7/2017

Open Access 01-07-2017 | Review Article

Current concepts in the diagnosis and management of extra-articular hip impingement syndromes

Authors: Naoki Nakano, Grace Yip, Vikas Khanduja

Published in: International Orthopaedics | Issue 7/2017

Login to get access

Abstract

Purpose

Extra-articular hip impingement syndromes encompass a group of conditions that have previously been an unrecognised source of pain in the hip and on occasion been associated with intra-articular hip impingement as well. As arthroscopic techniques for the hip continue to evolve, the importance of these conditions has been recognised recently and now form an important part of the differential of an individual presenting with hip pain. The aim of this article, therefore, is to provide the reader with an evidence-based and comprehensive update of these syndromes.

Methods

By reviewing past literature, the anatomy, pathophysiology, clinical features and the management of the five common extra-articular hip impingement syndromes were described.

Results

The common extra-articular impingement syndromes are: 1) Ischiofemoral impingement: quadratus femoris muscle becomes compressed between the lesser trochanter and the ischial tuberosity. 2) Subspine impingement: mechanical conflict occurs between an enlarged or malorientated anterior inferior iliac spine and the distal anterior femoral neck. 3) Iliopsoas impingement: mechanical conflict occurs between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology. 4) Deep gluteal syndrome: pain occurs in the buttock due to the entrapment of the sciatic nerve in the deep gluteal space. 5) Pectineofoveal impingement: pain occurs when the medial synovial fold impinges against overlying soft tissue, primarily the zona orbicularis. Knowledge for these syndromes still remains limited for reasons mostly relating to their low prevalence and their co-existence with typical femoro-acetabular impingement.

Conclusions

The knowledge of extra-articular hip impingement syndromes is essential and should form a part of the differential diagnoses alongside intra-articular pathology including femoro-acetabular impingement particularly in the younger patient with a non-arthritic hip.
Literature
1.
Alshameeri Z, Khanduja V (2014) The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint. Int Orthop 38(8):1615–20CrossRefPubMedPubMedCentral
2.
Johnson KA (1977) Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am 59(2):268–9CrossRefPubMed
3.
Tosun O et al (2012) Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skelet Radiol 41(5):575–87CrossRef
4.
Bredella MA et al (2015) Pelvic morphology in ischiofemoral impingement. Skelet Radiol 44(2):249–53CrossRef
5.
6.
Viala P et al (2012) Bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. Skelet Radiol 41(12):1637–40CrossRef
7.
Patti JW et al (2008) Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skelet Radiol 37(10):939–41CrossRef
8.
Ali AM, Whitwell D, Ostlere SJ (2011) Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skelet Radiol 40(5):653–6CrossRef
9.
10.
Sussman WI, Han E, Schuenke MD (2013) Quantitative assessment of the ischiofemoral space and evidence of degenerative changes in the quadratus femoris muscle. Surg Radiol Anat 35(4):273–81CrossRefPubMed
11.
12.
13.
Torriani M et al (2009) Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol 193(1):186–90CrossRefPubMed
14.
Martin HD et al (2010) The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy 26(2):161–72CrossRefPubMed
15.
Safran M, Ryu J (2014) Ischiofemoral impingement of the hip: a novel approach to treatment. Knee Surg Sports Traumatol Arthrosc 22(4):781–5CrossRefPubMed
16.
Jones CW, Biant LC, Field RE (2009) Dislocation of a total hip arthroplasty following hip arthroscopy. Hip Int 19(4):396–8PubMed
17.
Ganz R et al (2013) The lesser trochanter as a cause of hip impingement: pathophysiology and treatment options. Hip Int 23(Suppl 9):S35–41CrossRefPubMed
18.
de Sa D et al (2014) Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy 30(8):1026–41CrossRefPubMed
19.
Ryan JM et al (2014) Origin of the direct and reflected head of the rectus femoris: an anatomic study. Arthroscopy 30(7):796–802CrossRefPubMed
20.
Hammoud S et al (2014) The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain. Sports Health 6(2):108–18CrossRefPubMedPubMedCentral
21.
Larson CM, Kelly BT, Stone RM (2011) Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 27(12):1732–7CrossRefPubMed
22.
Hetsroni I et al (2013) Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 471(8):2497–503CrossRefPubMedPubMedCentral
23.
Hetsroni I et al (2012) Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy 28(11):1644–53CrossRefPubMed
24.
Pan H et al (2008) Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg (Br) 90(5):677–9CrossRef
25.
Matsuda DK, Calipusan CP (2012) Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics 35(3):e460–3PubMed
26.
Rossi F, Dragoni S (2001) Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skelet Radiol 30(3):127–31CrossRef
27.
Hapa O et al (2013) Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression. Arthroscopy 29(12):1932–40CrossRefPubMed
28.
29.
Blomberg JR, Zellner BS, Keene JS (2011) Cross-sectional analysis of iliopsoas muscle-tendon units at the sites of arthroscopic tenotomies: an anatomic study. Am J Sports Med 39(Suppl):58S–63SCrossRefPubMed
30.
Tatu L et al (2001) Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat 23(6):371–4CrossRefPubMed
31.
32.
Wenger DE et al (2004) Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res 426:145–50CrossRef
33.
Studler U et al (2008) MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 249(3):947–54CrossRefPubMed
34.
Alpert JM et al (2009) Cross-sectional analysis of the iliopsoas tendon and its relationship to the acetabular labrum: an anatomic study. Am J Sports Med 37(8):1594–8CrossRefPubMed
35.
Blankenbaker DG et al (2012) Labral injuries due to iliopsoas impingement: can they be diagnosed on MR arthrography? AJR Am J Roentgenol 199(4):894–900CrossRefPubMed
36.
Di Lorenzo L, Jennifer Y, Pappagallo M (2009) Psoas impingement syndrome in hip osteoarthritis. Joint Bone Spine 76(1):98–100CrossRefPubMed
37.
Cascio BM, King D, Yen YM (2013) Psoas impingement causing labrum tear: a series from three tertiary hip arthroscopy centers. J La State Med Soc 165(2):88–93PubMed
38.
Cobb JP et al (2011) Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction. J Bone Joint Surg (Br) 93(7):881–5CrossRef
39.
Browne JA et al (2011) Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement. J Arthroplasty 26(6):978, e5-8CrossRefPubMed
40.
41.
Jerosch J, Neuhauser C, Sokkar SM (2013) Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement. Arch Orthop Trauma Surg 133(10):1447–54CrossRefPubMed
42.
Winston P et al (2007) Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med 35(1):118–26CrossRefPubMed
43.
Flanum ME et al (2007) Arthroscopic treatment of the painful “internal” snapping hip: results of a new endoscopic technique and imaging protocol. Am J Sports Med 35(5):770–9CrossRefPubMed
44.
Ilizaliturri VM Jr et al (2005) Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy 21(11):1375–80CrossRefPubMed
45.
Tey M, Alvarez S, Rios JL (2012) Hip labral cyst caused by psoas impingement. Arthroscopy 28(8):1184–6CrossRefPubMed
46.
Nelson IR, Keene JS (2014) Results of labral-level arthroscopic iliopsoas tenotomies for the treatment of labral impingement. Arthroscopy 30(6):688–94CrossRefPubMed
47.
Dora C et al (2007) Iliopsoas impingement after total hip replacement: the results of non-operative management, tenotomy or acetabular revision. J Bone Joint Surg (Br) 89(8):1031–5CrossRef
48.
Ilizaliturri VM Jr et al (2014) Central compartment release versus lesser trochanter release of the iliopsoas tendon for the treatment of internal snapping hip: a comparative study. Arthroscopy 30(7):790–5CrossRefPubMed
49.
Ilizaliturri VM Jr et al (2009) Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy 25(2):159–63CrossRefPubMed
50.
Kulcu DG, Naderi S (2008) Differential diagnosis of intraspinal and extraspinal non-discogenic sciatica. J Clin Neurosci 15(11):1246–52CrossRefPubMed
51.
Martin HD et al (2011) The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy 27(2):172–81CrossRefPubMed
52.
Smoll NR (2010) Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 23(1):8–17
53.
Beaton LE, Anson BJ (1937) The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Record. 70:1–5
54.
Coppieters MW et al (2006) Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test. J Orthop Res 24(9):1883–9
55.
Wall EJ et al (1992) Experimental stretch neuropathy. Changes in nerve conduction under tension. J Bone Joint Surg (Br) 74(1):126–9
56.
Hernando MF et al (2015) Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skelet Radiol 44(7):919–34
57.
Benzon HT et al (2003) Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology 98(6):1442–8
58.
Fanucci E et al (2001) CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol 11(12):2543–8
59.
Filler AG et al (2005) Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2(2):99–115
60.
Young IJ, van Riet RP, Bell SN (2008) Surgical release for proximal hamstring syndrome. Am J Sports Med 36(12):2372–8
61.
Meknas K et al (2009) Surgical release of the internal obturator tendon for the treatment of retro-trochanteric pain syndrome: a prospective randomized study, with long-term follow-up. Knee Surg Sports Traumatol Arthrosc 17(10):1249–56
62.
Benson ER, Schutzer SF (1999) Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am 81(7):941–9
63.
Issack PS et al (2008) Sciatic nerve release following fracture or reconstructive surgery of the acetabulum. Surg Technique J Bone Joint Surg Am 90(Suppl 2 Pt 2):227–37
64.
Dezawa A, Kusano S, Miki H (2003) Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy 19(5):554–7
65.
Martin HD, Reddy M, Gomez-Hoyos J (2015) Deep gluteal syndrome. J Hip Preserv Surg 2(2):99–107
66.
May O, Boyer T, Dorfmann H (2004) Pectineofoveal pathology and arthroscopic treatment. Rev Chir Orthop Reparatrice Appar Mot 90:182
67.
Aprato A et al (2014) Peri-articular diseases of the hip: emerging frontiers in arthroscopic and endoscopic treatments. J Orthop Traumatol 15(1):1–11
68.
Dienst M et al (2001) Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity. Arthroscopy 17(9):924–31
69.
Bardakos NV (2015) Hip impingement: beyond femoroacetabular. J Hip Preserv Surg 2(3):206–23
70.
Nakano N, Khanduja V (2017) Medial synovial fold cyst in the hip leading to pectineofoveal impingement. J Hip Preserv Surg 4(1):93–96. doi:10.​1093/​jhps/​hnw043
71.
Blankenbaker DG et al (2009) MRI appearance of the pectinofoveal fold. AJR Am J Roentgenol 192(1):93–5
Metadata
Title
Current concepts in the diagnosis and management of extra-articular hip impingement syndromes
Authors
Naoki Nakano
Grace Yip
Vikas Khanduja
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 7/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3431-4

Other articles of this Issue 7/2017

International Orthopaedics 7/2017 Go to the issue

Original Paper

Radiological, clinical and functional evaluation using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire of children with medial epicondyle fractures treated surgically

Original Paper

Pre-operative intra-articular deep tissue sampling with novel retrograde forceps improves the diagnostics in periprosthetic joint infection

Original Paper

Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail

Original Paper

Linear relationship between lateralization of the bicipital groove and humeral retroversion and its link with the biepicondylar humeral line. Anatomical study of seventy cadaveric humerus scans

Original Paper

Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls

Editorial

Bone and joint infection, from prevention to complications