PMC4900207_01
57-year-old female with ischiofemoral impingement. Axial T1-weighted image of the right hip through the lesser trochanter shows narrowing of the ischiofemoral (solid line) and quadratus femoris (dashed line) spaces. I = ischium, F = femur, QF = quadratus femoris
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MRI images showed narrowing of the quadratus femoris and ischiofemoral spaces, which measured 8 mm and 17 mm, respectively (Fig. 1).
57-year-old female with ischiofemoral impingement. Axial PD FS image shows increased signal in the belly of the quadratus femoris muscle, consistent with edema (arrow). Increased signal around the iliopsoas insertion is thought to be from extravasation of intra-articularly injected gadolinium. I = ischium, F = femur.
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There was also a mild focal edema in the belly of the quadratus femoris muscle (Fig. 2).
57-year-old female with ischiofemoral impingement. Grayscale US image through the ischiofemoral space during a steroid injection demonstrates needle placement into the ischiofemoral space (arrows). Due to technical difficulties, the ischiofemoral space is not well delineated on US. Once the needle is placed through the proximal hamstring tendons (not shown), the needle is further advanced by about 2 cm to reach the quadratus femoris.
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The first injection was performed with ultrasound (US) guidance, and immediate relief of symptoms lasting for 9 months was achieved (Fig. 3).
57-year-old female with ischiofemoral impingement. CT scout view (A) and axial CT images through the lesser trochanter during a steroid injection demonstrate asymmetric narrowing of the right ischiofemoral and quadratus femoris spaces (B) and placement of a 10cm-long 22-gauge spinal needle through the proximal hamstring tendons (straight arrow), into the ischiofemoral space (C). In the prone position, both hips were externally rotated, slightly more on the right side. Oval indicates sciatic nerve. QF = quadratus femoris.
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The third injection was performed with computed tomography (CT) guidance, and the patient had continued relief for 9 months (Fig. 4).  The patient has reported symptoms of tightness at the proximal hamstring tendons, which has been relieved with stretching activities.