Iliopsoas Bursitis

Aka: Iliopsoas Bursitis, Internal Snapping Hip, Iliopsoas Strain, Iliopsoas Syndrome, Iliopsoas Tendonitis

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II. Pathophysiology

  1. Iliopsoas bursa
    1. Between psoas Muscle and femoral head
  2. Bursa irritated by overuse and friction
    1. Tendon rubs against pubic iliopectineal eminence

III. Mechanism: Sports with hip flexor use

  1. Soccer
  2. Ballet
  3. Uphill Running
  4. Hurdling
  5. Jumping

IV. Symptoms

  1. Deep Groin Pain
  2. Pain radiates to anterior hip or thigh
  3. Limp may occur
  4. Snapping Sensation (Iliopsoas Bursitis)
    1. May also occur with Hip Labral Tears, hip subluxation

V. Signs

  1. Difficult to diagnose (delayed often >31 months)
  2. Pain on deep palpation of femoral triangle (iliopsoas musculotendinous junction)
    1. Lateral to femoral nerve
    2. Inferior to inguinal ligament
    3. Medial to sartorius Muscle
  3. Provocative maneuvers
    1. Hip Flexion against resistance
    2. Passive extension of affected hip
    3. Supine patient raises heels off table to 15 degrees
      1. Strains iliopsoas Muscle

VI. Associated Conditions

  1. Snapping Hip Syndrome

VII. Radiology

  1. MRI hip shows fluid adjacent to Muscle

VIII. Management

  1. Conservative management
    1. Relative rest
    2. Hip flexor stretches and strengthening
    3. Hip rotator stretches and strengthening
  2. Image guided Corticosteroid Injection may offer relief
  3. Surgical management rarely indicated

IX. References

  1. Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
  2. Johnston (1998) Sports Med 25:271-83 [PubMed]
  3. Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]

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