Piriformis Syndrome Masquerading as an Ischiofemoral Impingement

Hip pain can have a number of different etiologies. Ischiofemoral impingement (IFI), an etiology causing extra-articular hip pain, shares many of the same symptoms as other causes of gluteal or inguinal pain, making its diagnosis difficult. We present a case of a young female with persistent deep gluteal pain who was diagnosed with IFI based on radiographic findings; however, a diagnostic injection into the quadratus femoris did not confirm IFI as the primary pain generator. The patient subsequently failed several trials of physical therapy designed to address this diagnosis. The diagnosis was expanded to include piriformis syndrome and the modified treatment approach resulted in complete resolution of her pain. The similarities of these pathologies resulted in a delay of definitive treatment and would have potentially required unnecessary surgery. This case study highlights the diagnostic conundrum clinicians face in the evaluation of gluteal hip pain and provides an algorithm for considering alternate diagnoses when conservative management fails to achieve expected results.