Iliopsoas Bursitis

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

advertisement

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 iliopsoas palpation at femoral triangle (iliopsoas musculotendinous junction)
    1. Lateral to femoral nerve and rectus abdominis Muscle
    2. Inferior to inguinal ligament
    3. Medial to sartorius Muscle
  3. Provocative maneuvers
    1. Hip Flexion against resistance
    2. Passive hip extension
    3. Supine patient raises heels off table to 15 degrees
      1. Strains iliopsoas Muscle

VI. Associated Conditions

  1. Snapping Hip Syndrome

VII. Imaging

  1. Hip XRay (consider Hip MRI)
    1. Comorbid hip pathology is common
  2. Dynamic Hip Ultrasound Indications
    1. Iliopsoas Bursitis
    2. Snapping Hip syndrome
  3. Hip MRI
    1. Demonstrates comorbid hip pathology
    2. Fluid adjacent to iliopsoas Muscle

VIII. Management

  1. Conservative management
    1. Relative rest
    2. Physical therapy directed at Iliopsoas strengthening and functional deficits
      1. Hip flexor stretches and strengthening
      2. Hip rotator stretches and strengthening
  2. Specialty referral Indications
    1. No improvement after >8-12 weeks of physical therapy
  3. Measures in Refractory Cases
    1. Ultrasound guided Iliopsoas bursa Corticosteroid Injection (may offer relief)
    2. 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. Maloy (2025) Am Fam Physician 111(4): 337-43 [PubMed]
  4. Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Iliopsoas Bursitis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Hip Disorders

advertisement