isquiofemoral impingement

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  • 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

    !

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    Diminuio da distncia entre a tuberosidade isquitica e o pequeno trocanter

    !

  • 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

    Sndrome)do)conflito)isquiofemoral):""Anca"dolorosa""Espao"isquio2"femoral""13mm""5mm"""Edema/Indefinio"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

    !

    MRI findings that shows reduced IFS with edema and wasting of quadratus femoris

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    1977!

    Johnson!KA.!

  • The Porto Hip Unit

    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

    !

    Diagnosis

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    Diagnosis

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    Rx e RM com alteraes evidentes Clinica Evidente

    Rx e RM com alteraes evidentes Clinica Duvidosa

    Rx e RM com alteraes evidentes Sem Clinica

    ?X

    V

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    Infiltracoes Diagnsticas/Terapeuticas

    Ropivacaina 7.5 % 3 ml + Triancinolona 40 mg

    Avaliar as primeiras 12 horas (1 dia) Avaliar os 2-3 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

    !

    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

  • The Porto Hip Unit

    PHM2015

    Ischiofemoral Impingement

    Conclusion

    ! !

    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, NSAIDs, 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

    www.portohipmeeting.com