What are the symptoms of ischiofemoral impingement in a 69‑year‑old woman?

Symptoms of Ischiofemoral Impingement

Ischiofemoral impingement presents with lower buttock pain, groin pain, and/or medial thigh pain that is characteristically worsened by hip extension, adduction, and external rotation. 1

Primary Pain Location and Distribution

• The hallmark symptom is pain in the lower buttock region, which may radiate to the groin and inner thigh 1, 2
• Pain onset is typically gradual rather than acute, distinguishing it from acute muscle tears 3
• The pain pattern is distinct from typical hip arthritis (which primarily causes groin pain) and femoroacetabular impingement (which also primarily causes groin pain) 4, 5

Provocative Movements and Activities

• Pain is characteristically exacerbated by a combination of hip extension, adduction, and external rotation 1, 2, 3
• Long-stride walking commonly provokes symptoms 2
• Extreme restriction of hip abduction and external rotation may be present on examination 6
• Some patients report a snapping or clunking phenomenon with hip movement 2

Physical Examination Findings

• Pain can be reproduced during physical examination by placing the hip in combined extension, adduction, and external rotation 3
• The affected hip may demonstrate marked limitation in abduction and external rotation range of motion 6
• Symptoms may mimic other conditions including iliopsoas tendonitis, hamstring injury, or bursitis, making clinical correlation essential 3

Key Diagnostic Considerations for a 69-Year-Old Woman

• MRI is the definitive imaging modality, showing narrowing of the ischiofemoral space (between the ischium and lesser trochanter) and signal abnormality in the quadratus femoris muscle 2, 6
• The quadratus femoris space should be specifically assessed on MRI imaging 2
• Targeted infiltration of the quadratus femoris muscle can serve both diagnostic and therapeutic purposes 2
• Plain radiographs should include axial or false-profile views of the hip in addition to standard pelvis views 2

Critical Pitfall to Avoid

• Do not confuse ischiofemoral impingement with more common causes of hip pain such as hip arthritis (groin-predominant pain with internal rotation reproduction) or femoroacetabular impingement (groin pain with FADIR test positivity) 4, 5, 3
• The posterior/buttock location of pain with extension-adduction-external rotation provocation is the key distinguishing feature 1, 3