Quadratus femoris muscle: spectrum of MR imaging findings in 51 patients presenting with painful hip

Evangelia E. Vassalou, Michail E. Klontzas, Peter Mercouris, Antonia Bintoudi, Margarita Natsika, Eleni Eracleous, Apostolos H Karantanas

Abstract


Purpose: To provide an overview of magnetic resonance (MR) imaging findings related to quadratus femoris muscle (QFm) pathologies in symptomatic patients.

Material and Methods: MR imaging studies from 51 patients, who were retrospectively recruited within a 2-year period, in 5 health care centers were reviewed. Inclusion criteria included: (i) hip pain; (ii) QFm abnormal signal; (iii) identification of other pathology in the QFm anatomical area. Exclusion criteria included: (i) other symptomatic hip/pelvic pathology; (ii) incomplete MR examination. The presence/location of QFm oedema and configuration of QFm fibers were evaluated and classified. Hamstring tendons were assessed for tendinosis/tear. Ischiofemoral impingement syndrome (IFIs) was indicated by QFm oedema and restriction of ischiofemoral space (IFS)/quadratus femoris space (QFS). QFm tears were categorised as complete/partial/chronic. Fisher’s exact test was used for statistical analysis.

Results: IFIs diagnosis, related to various aetiologies, was suggested in 39 patients. The absence of severe QFm oedema and crowded configuration of QFm fibers correlated with IFIs diagnosis (p<0.05). In 18/39 (46.2%) of patients, restriction of the IFS/QFS was due to an underlying pathology. QFm tears were diagnosed in 5 patients. QFm oedema, usually mild, located at the myotendinous junction, was revealed in 4/5 patients. In 7 patients various pathologies related to the QFm were disclosed, which broadly included neoplastic disorders, myositis and bursitis.

Conclusions: MR imaging can depict and characterise various QFm pathologies including IFIs, traumatic lesions, myositis and neoplastic disorders.  Detailed analysis of the oedema pattern and the configuration of muscular fibers matched with clinical findings can lead to precise diagnosis.


Keywords


impingement syndromes/ischiofemoral; quadratus femoris muscle/disorders; MR imaging/diagnosis; hip pain

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References


Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy 2008; 24: 1407-1421.

O’Brien SD, Bui-Mansfield LT. MRI of quadratus femoris muscle tear: another cause of hip pain. AJR Am J Roentgenol 2007; 189: 1185-1189.

Kassarjian A. Signal abnormalities in the quadrates femoris muscle: tear or impingement? (letter). AJR Am J Roentgenol 2008; 190: W379.

Bano A, Karantanas A, Pasku D, et al. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report. J Med Case Rep 2010; 4: 236.

Kassarjian A, Tomas X, Cerezal L, et al. MRI of the quadratus femoris muscle: anatomic considerations and pathologic lesions. AJR Am J Roentgenol 2011; 197: 170-174.

Zibis AH, Fyllos AH, Karantanas AH, et al. Quadratus femoris tear as an unusual cause of hip pain: a case report. Hip Int 2016; 26(1): e7-9.

Maraş Özdemir Z, Aydıngöz Ü, Görmeli CA, et al. Ischiofemoral space on MRI in an asymptomatic population: normative width measurements and soft tissue signal variations. Eur Radiol 2015; 25: 2246-2253.

Papavasiliou A, Siatras T, Bintoudi A, et al. The gymnasts’ hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skeletal Radiol 2014; 43: 1071-1077.

Tosun O, Algin O, Yalcin N, et al. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiol 2012; 41: 575-587.

Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg Br 2011; 93: 1300.

Torriani M, Souto SCL, Thomas BJ, et al. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol 2009; 193: 186-190.

Vaarbakken K, Steen H, Samuelsen G, et al. Primary functions of the quadratus femoris and obturator externus muscles indicated from lengths and moment arms measured in mobilized cadavers. Clin Biomech (Bristol, Avon) 2015; 30: 231-237.

Bredella MA, Azevedo DC, Oliveira AL, et al. Pelvic morphology in ischiofemoral impingement. Skeletal Radiol 2015; 44: 249-253.

Vassalou EE, Zibis AH, Klontzas ME, et al. Imaging of impingement syndromes around the hip joint. Hip Int 2017; 27(4): 317-328.

Park S, Lee HY, Cuong PM, et al. Supine versus standing radiographs for detecting ischiofemoral impingement: A Propensity score-matched analysis. AJR Am J Roentgenol 2016; 206: 1253-1263.

Taneja AK, Bredella MA, Torriani M. Ischiofemoral impingement. Magn Reson Imaging Clin N Am 2013; 21: 65-73.

Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am 1977; 59: 268-269.

Hayat Z, Konan S, Pollock R. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings. BMJ Case Rep 2014; 25: 2014.

Viala P, Vanel D, Larbi A, et al. Bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. Skeletal Radiol 2012; 41: 1637-1640.

Yoong P, Mansour R, Teh JL. Multiple hereditary exostoses and ischiofemoral impingement: a case-control study. Skeletal Radiol 2014; 43: 1225-1230.

Johnson AC, Hollman JH, Howe BM, et al. Variability of ischiofemoral space dimensions with changes in hip flexion: an MRI study. Skeletal Radiol 2017; 46: 59-64.

Peltola K, Heinonen OJ, Orava S, et al. Quadratus femoris muscle tear: an uncommon cause for radiating gluteal pain. Clin J Sport Med 1999; 9: 228-230.

Willick SE, Lazarus M, Pres JM. Quadratus femoris muscle strain. Clin J Sports Med 2002; 12: 130-131.


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