Disclosures: Subha Hanif, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 44-year-old female with a past medical history of arthritis, depression and migraines presented with a chief concern of left hip and groin pain for 6 months.

Case Description or Program Description: Initially, the patient presented to the spine clinic with left leg pain and low back pain for one year. MRI of the L-spine revealed severe left L5 foraminal narrowing. She failed conservative care, including therapy and injections. In the interim, the patient developed pain in the left groin with hip flexion and internal rotation without inciting event. On exam, the patient had a positive left FABER test, tenderness over the left SI joint, and pain with internal rotation of the left hip with a normal neurological exam.

Setting: Outpatient clinic

Assessment/Results: MRI of the pelvis showed findings typical of ischiofemoral impingement: edema in both quadratus femoris muscle bellies and narrowing of the bilateral ischiofemoral intervals. Electrodiagnostic testing showed evidence of an old L5-S1 radiculopathy without active denervation but was otherwise unremarkable.

Discussion (relevance): This case highlights a rare case of ischiofemoral impingement syndrome in a complicated patient. She underwent surgical intervention for presumed left L5 radiculopathy which produced no relief of her left leg symptoms. We propose the radicular symptoms in this patient may be related to intermittent compression of the sciatic nerve within the ischiofemoral interval.

Conclusions: Ischiofemoral impingement syndrome is often an unrecognized although rare cause of hip pain, with potential to mimic radiculopathy. This diagnosis is important to consider in female patients presenting with hip pain and radicular symptoms. The diagnosis can be confirmed by physical exam, provocative tests, and imaging. Initial treatment can be conservative with physical therapy, nonsteroidal anti-inflammatory drugs, and injection therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ischiofemoral-impingement-a-rare-cause-of-radicular-pain/