Ischiofemoral Impingement: Pathophysiology, Diagnosis, and Treatment

Ischiofemoral impingement is an under-recognized source of buttock and groin pain resulting from abnormal contact between the proximal femur and the ischium. Entrapment of the quadratus femoris muscle results in pain, mechanical symptoms and in some cases irritation of the sciatic nerve. Characteristic MRI findings include narrowing of the ischiofemoral space and quadratus femoris edema or atrophy. The diagnosis is confirmed with guided injections. Recalcitrant symptoms are treated with surgical decompression of the ischiofemoral space either directly, via open or endoscopic approaches, or indirectly through femoral osteotomy or in rare cases hip arthroplasty.