Persistent Groin/Buttock Pain Oft Post Hip Surgery Cause and Treatment

Close proximity of pelvis side wall (Ischium) and lesser trochanter of hip can cause pains in groin or buttocks. This ischiofemoral-impingement might required trimming or lesser trochanter. This is new to me.

Hernandez, Alejandro, et al.
Ischiofemoral Impingement Syndrome: Outcomes of Endoscopic Resection of the Lesser Trochanter.
Clinics in orthopedic surgery 9.4 (2017): 529-533.

  • at this stage, there are more just case reports
  • ‘”Ischiofemoral impingement syndrome (IFIS) is a rare clinical entity characterized by chronic groin, buttock or hip pain associated with radiographic evidence of narrow- ing of the space between the lesser femoral trochanter and
    the ischial tuberosity.”
  • hip trauma or hip replacement might precede
  • tenderness to quadratus femoris muscle might exist
  • neurogenic pain level might accompany
  • ischiofemoral impingement (ISFI) test: -side-lying,  sweep bad leg back in extension with hip abducted (sore ) or not abducted (not sore)

Martin, Hal David, Ian J. Palmer, and Munif A. Hatem.
Deep gluteal syndrome.
Hip Arthroscopy and Hip Joint Preservation Surgery (2013): 1-30.

They suggest you do several tests to R/O piriformis:

  • Being a doctor that does pelvics and rectals, I know the most sensitive test for a piriformis is tenderness in sciatic notch on palpation
  • Xrays finding would be less than a 2 mm space for ISFI
  • Resection of lesser trochanter arthroscopically can take pain from 7-8 to 0-2\10
  • In milder cases, repeated injection of Polydeoxyribonucleotide Sodium were found helpful – they called it prolotherapy but I have never heard of anyone using it that way:
    Ultrasound-guided Prolotherapy with Polydeoxyribonucleotide Sodium in Ischiofemoral Impingement Syndrome
    Won-Joong Kim et al
    Pain practice 14(7) sept 2014; 649-655

Comment – impingements after hip surgery often involve psoas muscle and botulinum injection in the psoas can help:
Fish, David E., and Wanda S. Chang.
Treatment of Iliopsoas Tendinitias After A Left Total Hip Arthroplasty with Botulinum Toxin Type A.
Pain Physician 10.4 (2007): 565.

  • Psoas muscle might snap over hip joint even

  • Inject 6 mls local by transverse processes of L2,3,4 – if that helps inject 33 units botulinum into each level – works well for awhile but needs repeating when wears off.


addendum – an isolated case of quadratus femoris issue managed by needling:

Physiother Theory Pract. 2018 Feb;34(2):157-164.
Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A
case report.
Anandkumar S

  • 40 yr old with pain posterior thigh x 8 months – gradual build up
  • trouble sitting for more than 20 minutes
  • “On palpation, tenderness was elicited over the right QF muscle between the ischial tuberosity and greater trochanter.”
  • needled and left in place for 20 minutes each time

Comment Quadratus femoris syndrome from impingment or not. Sitting is an issue and needling or prolotherapy might help


addendum – had patient today with spinal stenosis and multiple issues buttock – was able to work out piriformis with transverse stretch massage for 15 minutes. Came in this week with pain at the last muscle quite low in buttock in quadratus femoris. Was tender on the pelvic side. I was able to needle and using a pointer plus (pulse- relax manually every second for 140 times). Did mention she had trouble crossing her legs but as soon as it came out had no trouble.

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