Download - Isquiofemoral Impingement
Ischiofemoral Impingement Tratamento endoscopico por abordagem posterior do
pequeno trocanter
Jorge Cruz de Melo
The Porto Hip Unit
PHM2015
The Porto Hip Unit
PHM2015
Ischiofemoral ImpingementThe hip has main bony sources for impingement ! Abnormal contact sites:- acetabulum vs femur - ischium vs femur
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The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Diminuição da distância entre a tuberosidade isquiática e o pequeno trocanter
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The Porto Hip Unit
PHM2015
Ischiofemoral ImpingementQ: Quadratus femoris muscle (QFM) is a flat muscle which has a orgin on the Lateral margin of the obturator ring above ischial tuberosity and insertion on the Quadrate tubercle and adjacent bone of intertrochanteric crest of proximal posterior femur.
IG: Inferior gemellus
OI: Obturator internius
SG: Superiorgemellus
P: PiriformisSN: Sciaticnerve.
Q: Quadratus femoris
Lesser trochanter
I: Ischium tuberosity
H: Hamstrings tendon
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Síndrome)do)conflito)isquiofemoral):""Anca"dolorosa""Espaço"isquio2"femoral"–"13mm"±"5mm"""Edema/Indefinição"do"M."QF"
Torriani defined: The ischiofemoral space (IFS) as a gap between the ischium tuberosity and the iliopsoas tendon or the lesser trochanter. The ischiofemoral space – 13mm ± 5mm
(23mm ± 8mm)
The quadratus femoris space (QFS) as the smallest gap between the superolateral surface of the hamstring tendons and the posteromedial surface of the iliopsoas tendon or the lesser trochanter.The quadratus femoris space - 7 mm ± 3mm (12mm ± 4mm)
Lesser trochanter
IschiumHamstrings Tendeon
Quadratus femoris muscle
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
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MRI findings that shows reduced IFS with edema and wasting of quadratus femoris
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
1977!
Johnson!KA.!
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PHM2015
Ischiofemoral Impingement
2008!
Kassarijan!A!
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2008!
Patti J W
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2009!
Torriani!M.!
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
2011!
Mohsan!A.!
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Idiopatic
! Previous surgery, fracture or arthrosis iopatic
! Hamstrings tendinopathy
! Positional
! Coxa valga
Etiology
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Non focal groin or buttock pain! Ischialgia with radiation to the medial thigh ! Painful popping, difficult to localize! Often diagnosed as “snapping iliopsoas”
Clinical presentation
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
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Diagnosis
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Diagnosis
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
• Rx e RM com alterações evidentes • Clinica Evidente
• Rx e RM com alterações evidentes • Clinica Duvidosa
• Rx e RM com alterações evidentes • Sem Clinica
?X
V
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Infiltracoes Diagnósticas/Terapeuticas
Ropivacaina 7.5 % 3 ml + Triancinolona 40 mg
Avaliar as primeiras 12 horas (1º dia) Avaliar os 2º-3º dias Avaliar 2 semanas depois
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Treatment! To modify activity + NSAID
Active rest & to avoid provoking activities
! Fisioterapy
! Injections: diagnostic & therapeutic
! To widen ischiofemoral space
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
Tratamento endoscopico por abordagem do pequeno trocanter
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! To widen ischiofemoral space
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Tratamento endoscopico por abordagem do pequeno trocanter
!
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! To widen ischiofemoral space
Tratamento endoscopico por abordagem do pequeno trocanter
Lesser Trochanter
Lesser Trochanter
Iliopsoas
Iliopsoas
Posterior Aproach
Iliopsoas
Lesser TrochanterLesser Trochanter
Anterior Aproach
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Posteriot Aproach
Tratamento endoscopico por abordagem do pequeno trocanter
VIDEO
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PHM2015
Ischiofemoral Impingement
Conclusion
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Pre-op Pos-op
The Porto Hip Unit
PHM2015
Ischiofemoral Impingement
! Ischiofemoral impingement could be the source of hip pain or ischialgia in women
! Idiopatic or acquired narrowing of the IFS could lead to edema and atrophy of the QFM ! Not all patients with IF Impingement have narrowing of the IFS ! Not all IF space narrowing or QFM edema are symptomatic ! In doubt, the diagnosis could be confirmed by local infiltration
! The conservative measures with rest, activity restriction, NSAID’s, physical therapy and steroid injection (image guided) may produce pain relief.
! Surgical treatment is reserved to patients in whom conservative treatment fails.! The endoscopic posterior approach is a very good solution (parcial reception of the
leser trochanter and preservation of iliopsoas tendon)
Conclusion
The Porto Hip Unit
PHM2015
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