Sonography of the iliopsoas tendon and injection of the iliopsoas Bursa for diagnosis and management of the painful snapping hip

Department of Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, United States
Skeletal Radiology (Impact Factor: 1.51). 09/2006; 35(8):565-71. DOI: 10.1007/s00256-006-0084-6
Source: PubMed


The purpose of this study was to compare sonographic evaluations of patients referred with suspected snapping of their iliopsoas tendon with the pain relief achieved from anesthetic injection of the iliopsoas bursa, and with the subsequent surgical outcome. This study also assessed the effectiveness of Kenalog injection into the iliopsoas bursa for long-term pain relief.
Dynamic and static sonography was performed in 40 patients with clinically diagnosed snapping hips. The iliopsoas bursa was injected with Bupivicaine and Lidocaine in the first 22 patients, and an additional 1 ml Kenalog-40 was added to this mixture in the last 18 patients. We compared the static and dynamic sonographic findings with change in the patients' level of pain at 2 days after anesthetic injection. The sonographic findings and response to anesthetic injection were also compared to the response to Kenalog injection and the results of any subsequent surgery.
Static sonography of the iliopsoas tendon was normal in 38 patients, and detected iliopsoas bursitis in one patient and iliopsoas tendinopathy in another. Snapping of the iliopsoas tendon was observed using dynamic sonography in 9 of the 40 patients. Following anesthetic injection of the iliopsoas bursa, 29 patients had complete or partial pain relief, and 11 patients had no pain relief. Eight of the nine patients with a snapping iliopsoas tendon had complete or partial pain relief from the bursal injection. Twelve of the 29 patients with pain relief after anesthetic injection later had an arthroscopic iliopsoas tendon release, and all of these 12 patients had a good postoperative result. Of the 18 patients who had Kenalog-40 injected into the iliopsoas bursa and did not have iliopsoas surgery, 16 had sustained pain relief following the injection.
Patients with groin pain and a clinically suspected snapping iliopsoas tendon can benefit from injection into the iliopsoas bursa even if the snapping tendon is not visualized sonographically. The use of a corticosteroid may provide long-term pain relief, and pain relief after injection is a predictor of good outcome after surgical release of the iliopsoas tendon.

194 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with a painful arthroplasty can present a clinical diagnostic dilemma. Aspirates are often negative for infection and alignment of the prosthesis on conventional radiographs is usually satisfactory. These patients can have a myriad of soft tissue as well as osseous pathologies, which may be clinically unsuspected or radiographically occult. The ability of advanced cross-sectional imaging to diagnose osseous and soft tissue injuries has been well documented, but applications to arthroplasty imaging are often limited by regional metallic artifacts. Adjustment of standard imaging parameters can make CT and MR imaging useful adjuncts in imaging the painful arthroplasty, especially in the setting of normal radiographs. Ultrasound can be used to evaluate the periprosthetic soft tissues and provide a real-time method of evaluating the dynamic relationship of the periprosthetic soft tissues to the arthroplasty components, and it also can be used as a guide for diagnostic and therapeutic interventions.
    No preview · Article · Apr 2007 · Skeletal Radiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sonography has been widely utilized for several decades in the diagnosis and follow-up of developmental dysplasia of the hip due to its ability to visualize the nonossified femoral head and portions of the acetabulum in neonates, dynamic capabilities, accuracy, and lack of nonionizing radiation. Furthermore, hip sonography is also used throughout parts of the world to diagnose and guide intervention for both children and adults. The hip joint, tendons, and periarticular structures can be delineated with sonography in a variety of congenital, developmental, infectious, inflammatory, arthritic, traumatic, and neoplastic disorders. The following discussion focuses on the sonographic technique and imaging characteristics of congenital and developmental anomalies of the hip in children, as well as the sonographic evaluation of the hip joint and tendons.
    No preview · Article · Jul 2007 · Seminars in musculoskeletal radiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A (BTX-A). Case study. Outpatient musculoskeletal clinic. Single patient subject with left iliopsoas tendinitis after a left total hip arthroplasty. Fluoroscopically guided injection of 100 units of BTX-A into the left iliopsoas muscle. Functional improvement with Oswestry Disability Index (ODI) and scores using a 0-10 point pain intensity numerical rating scale (PI-NRS) at one and 6 months follow up. A 71-year-old female with 4 months of left groin pain after successful total hip arthroplasty. Work up did not reveal any infection or malpositioning of the left hip prosthetic components. Attempts at aspiration revealed no fluid in the joint space. A positive xylocaine muscle block confirmed a diagnosis of iliopsoas tendinitis. The BTX-A injection resulted in an improved left groin pain rating from a baseline of 7 to 1 and improved ability to flex her left hip at one month follow up. Pain was rated 8 at six months follow up. ODI improved from a baseline of 26% to 22% at one month follow up and 18% at 6 months follow up. Iliopsoas tendinitis is an uncommon cause of groin pain but has been described after a total hip arthroplasty in several case reports. Non-operative management has not been well established but includes anesthetic and corticosteroid injection into the muscle. The use of botulinum toxin A provided significant pain relief, functional improvement, and may represent an alternative to the surgical management of iliopsoas tendinitis.
    Preview · Article · Aug 2007 · Pain physician
Show more