Disclosures: Haruki Ishii, MD: No financial relationships or conflicts of interest

Case Diagnosis: Ischiofemoral Impingement Syndrome

Case Description: A 31-year-old female presented with an intermittent localized left hip pain that began when training for a marathon. Despite the pain, she continued running. However, the pain progressively worsened over one year refractory to analgesics, now radiating to the groin and buttock. A hip MRI showed focal labral tear, and she was referred to physical therapy with some improvement. Six months later, she was now unable to run a short distance due to the pain. The pain was sharp and most noticeable in her groin and buttock, associated with “clicking” sound without weakness or paresthesia. Physical exam was unremarkable except for positive FABER sign without snapping or clicking with hip range of motion.

Setting: OutpatientAssessment/

Results: A femur MRI revealed minimal increased T2 intramuscular edema signal involving the left quadratus femoris with mild fatty infiltration. The distance between lesser trochanter of the femur and ischial bone measured approximately 2.5cm, suggestive of ischiofemoral impingement syndrome (IFIS).

Discussion: Hip and groin pain affects patients of all ages. IFIS is a rare cause of groin, gluteal, or hip pain with a strong female predominance, associated with edema or atrophy in the quadratus femoris muscle and narrowing of the space between the lesser femoral trochanter and the ischial tuberosity. Given lack of specific clinical findings, it is often confused with other injuries, including piriformis syndrome, sacroiliac joint pain, and proximal hamstring tendinopathy. Ultrasound-guided corticosteroid injection of the quadratus femoris muscle has been described as a promising diagnostic and therapeutic option combined with physical therapy focusing on strengthening the hip external rotators and abductors.

Conclusion: Although hip pain can introduce a diagnostic dilemma even to experienced clinicians, this case highlights that IFIS should be included in differential diagnosis when evaluating a female runner with hip pain for timely management to ensure safe return to sports.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ischiofemoral-impingement-syndrome-an-unusual-presentation-of-chronic-hip-pain-in-a-recreational-marathon-runner-a-case-report/