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Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
As a synovial joint (see joint classification), the hip joint is surrounded by a fibrous capsule. Thickenings of this capsule form the three external ligaments of the hip. These ligaments spiral from the pelvis to the femur, providing strong support for the joint. The most anterior ligament is the iliofemoral ligament, also known as the Y-ligament because it has a characteristic inverted Y-shape. This ligament arises from the anterior inferior iliac spine and acetabular rim of the pelvis, winding anteriorly and distally to attach at two points on the intertrochanteric line on the proximal anterior femur. The major role of this ligament is to prevent hyperextension of the hip joint. The pubofemoral ligament has an anteroinferior position. It attaches to the obturator crest, laterally on the pubic bone and runs laterally and distally to blend with the iliofemoral ligament at its femoral attachment. This ligament prevents excessive abduction of the hip joint. The third capsular ligament lies posterior to the hip joint. The ischiofemoral ligament arises from the ischial part of the rim of the acetabulum, spiralling proximally and laterally to attach to the superior surface of the neck of the femur, just medial to the greater trochanter. This ligament is the weakest of the three. All of the ligaments become tighter during hip extension, preventing hyperextension and pushing the head of the femur into the acetabulum and maximizing the stability of the joint.
Hip preservation techniques
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
The rapid evolution of hip arthroscopy and advances in 3-D imaging, instrumentation, and surgical techniques are making it possible for surgeons now to perform procedures that were once typically performed by “open techniques” through arthroscopy. Various other extra-articular sources of pain, such as subspine impingement, ischiofemoral impingement, and trochanteric pelvic impingement, are identified arthroscopically in the evolution of hip preservation surgery. This particularly involves the sports medicine and orthopedic community.
Minimally invasive surgery of the hip joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Matthew K. T. Seah, Wasim Khan
Less common therapeutic indications for hip arthroscopy include ischiofemoral impingement [40]; sciatic nerve entrapment [41]; synovial chondromatosis and pathology of the psoas tendon, iliotibial band and ligamentum teres [42]. Applications continue to expand, and hip arthroscopy is also used to facilitate hip reduction in infants with development dysplasia of the hip [43] and for the treatment of extracapsular pathology, including iliopsoas tendon and iliotibial band pathology [44].
Hip physical examination extension loss and radiographic osseous findings in patients with low back pain and nonarthritic hips
Published in Baylor University Medical Center Proceedings, 2022
Richard Feng, Munif Hatem, Scott J. Nimmons, Ashley Disantis, RobRoy L. Martin, Hal David Martin
Pathologies limiting hip flexion, especially femoroacetabular impingement, have been frequent subjects of orthopedic hip research over the last three decades.1 However, pathologies limiting hip extension (HE) are more important for activities that require an upright posture.2,3 While a loss of HE in nonarthritic hips is traditionally linked to tightness of the musculotendinous structures anterior to the hip joint,4–6 osseous etiologies such as ischiofemoral impingement and abnormal femoral torsion can also limit HE.7–11 The association between hip and spine abnormalities is known as hip-spine syndrome, and limitation in HE has been associated with low back pain (LBP).8,12 Given the potential link between osseus abnormalities and limited HE, the purpose of this study was to assess radiographic osseous findings in nonarthritic hips of patients with hip pain, LBP, and limited HE. A secondary purpose was to determine the utility of adding abduction and internal and external rotation to HE during the physical examination to assess the osseous contribution to limited HE.
Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient
Published in Baylor University Medical Center Proceedings, 2021
Munif Hatem, RobRoy L. Martin, Scott J. Nimmons, Hal David Martin
The positioning of the patient during the imaging acquisition is variable among authors describing the normal IFS in different populations.6,8,10,11 Considering that the interpretation of the IFS assessed in hip MRI by clinicians is dependent on the lower limb positioning during MRI acquisition, including this information on the exam report would be helpful in the diagnosis and surgical planning for ischiofemoral impingement. In addition to decreased IFS, the physical examination and additional imaging findings are essential to determine whether the impingement between the lesser trochanter and ischium has clinical repercussion. The ischiofemoral impingement test, long-stride walking test, and hip-spine extension test are included in the physical examination to diagnose ischiofemoral impingement.1,4,12 Helpful findings to diagnose ischiofemoral impingement in standing radiographs include the presence of asymmetric IFS and sclerosis and cystic changes at the ischial tuberosity. The presence of signal changes at the quadratus femoris muscle and adjacent hamstring tendons is another finding supporting the diagnosis of ischiofemoral impingement (Figure 7).6,13
Extra-articular hip impingement: clinical presentation, radiographic findings and surgical treatment outcomes
Published in The Physician and Sportsmedicine, 2019
Ischiofemoral impingement was first described in 1977, identified in a series of patients with previous intertrochanteric hip fractures, with malunions resulting in a reduction of the ischiofemoral space and impingement of the quadratus femoris [24]. The ischiofemoral space is defined as the space between the lateral margin of the ischial tuberosity and the medial edge of the lesser trochanter, which is an average of 20 mm in diameter [24,25]. The quadratus femoris muscle occupies this space and can be compressed if the available space is reduced. However, even following its preliminary description, this entity was not considered as a possible cause of hip pain in an uninjured or unoperated patient for several years thereafter. More recently, it has been identified as a cause of impingement with a number of theories proposed regarding the mechanism by which this ischiofemoral space is reduced. This has included traumatic injuries (i.e. intertrochanteric fractures, or bony avulsions of the ischium or lesser trochanter [LT] in pediatric patients), as well as degenerative processes (OA with medialization of the femoral head), and finally alterations in proximal femoral morphology (coxa breva, coxa valga, excessive femoral anteversion or hip dysplasia) [24,26].