title: Current concepts in the diagnosis and management of extra-articular hip impingement syndromes.
abstract: Extra-articular hip impingement syndromes encompass a group of conditions that have previously been an unrecognised source of pain in the hip and on occasion been associated with intra-articular hip impingement as well. As arthroscopic techniques for the hip continue to evolve, the importance of these conditions has been recognised recently and now form an important part of the differential of an individual presenting with hip pain. The aim of this article, therefore, is to provide the reader with an evidence-based and comprehensive update of these syndromes.
  
  
  
  By reviewing past literature, the anatomy, pathophysiology, clinical features and the management of the five common extra-articular hip impingement syndromes were described.
  
  
  
  The common extra-articular impingement syndromes are: 1) Ischiofemoral impingement: quadratus femoris muscle becomes compressed between the lesser trochanter and the ischial tuberosity. 2) Subspine impingement: mechanical conflict occurs between an enlarged or malorientated anterior inferior iliac spine and the distal anterior femoral neck. 3) Iliopsoas impingement: mechanical conflict occurs between the iliopsoas muscle and the labrum, resulting in distinct anterior labral pathology. 4) Deep gluteal syndrome: pain occurs in the buttock due to the entrapment of the sciatic nerve in the deep gluteal space. 5) Pectineofoveal impingement: pain occurs when the medial synovial fold impinges against overlying soft tissue, primarily the zona orbicularis. Knowledge for these syndromes still remains limited for reasons mostly relating to their low prevalence and their co-existence with typical femoro-acetabular impingement.
  
  
  
  The knowledge of extra-articular hip impingement syndromes is essential and should form a part of the differential diagnoses alongside intra-articular pathology including femoro-acetabular impingement particularly in the younger patient with a non-arthritic hip.
authors.affiliation: Consultant Orthopaedic Surgeon & Associate Lecturer, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakano
authors.affiliation: Consultant Orthopaedic Surgeon & Associate Lecturer, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
authors.forename: Grace
authors.initials: G
authors.lastname: Yip
authors.affiliation: Consultant Orthopaedic Surgeon & Associate Lecturer, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK. vk279@cam.ac.uk.
authors.forename: Vikas
authors.identifier: 0000-0001-9454-3978
authors.initials: V
authors.lastname: Khanduja
mesh_terms: D003937:Diagnosis, Differential; D057925:Femoracetabular Impingement / Q000175:diagnosis*; D006621:Hip Joint; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis; D059352:Musculoskeletal Pain / Q000209:etiology*; D013577:Syndrome
keywords: Arthroscopy; Deep gluteal syndrome; Extra-articular impingement; Hip pain; Iliopsoas impingement; Ischiofemoral impingement; Pectineofoveal impingement; Subspine impingement