Iliopsoas
- TVP of L1-L5, lateral surfaces of lx vertebra and intervertebral discs
- Iliacus - iliac fossa
- Lesser Tronchantar
- Hip flex and ext rot
- Bursa lies between ilipsoas musculotendinous junction and bony pelvis
A clicky Hip
- Consider muscular/tendinous causes if it happens everytime the hip moves |
- Tightness of iliopsoas is the usual cause (rubbing of tendon over underlying bony landmarks - anterior capsule of femoral head, lesser trochanter, ilioectineal eminence and ASIS) |
- Painless = asymptomatic internal snapping hip |
- Painful = painful internal snapping hip, internal coxa saltans, iliopsoas tendinits, iliopsoas tendinosis, iliopsoas tendinopathy, bursitis, ilipsoas sydnrome |
- External snapping hip should be considered too - iliotibial band/glut max tightness - rubs over GT
intraarticular snapping = loose bodies, labral tears, dislocation |
Causes
- Irritation of tendon by injury (direct or eccentric contraction)/repetitive microtrauma (flex and ext rot) |
- Dancers, jumpers, football, running, hurdling, gymnastics, rowing suspectable |
- Adolescents (growth spurts - inflexability of the hip flexors) |
Hx
- Palpable/audible snapping provoked by flex and ext of the hip |
- Deep groin pain radiates to anterior hip/thigh |
- Can have altered gait/weakness if chronic |
- Lower back pain |
- Difficulty standing straight |
PE
- Hip in flex and ext rot and ant pelvic tilt (can be present in hip effusion - open packed position) |
- Gait - shortened stride length and increased knee flexion |
- TTP femoral triangle, lesser tronchanter |
- Pain/limited PROM hip ext, AROM/RROM discomfort |
- +ve Thomas test |
- +ve ASLR |
- Weakness/pain during ilipsoas strength test - look for patient rotating their body (core weakness) |
- Assess for hip abductor weakness, LCS, spinal instabilty, dysfunctional breathing, foot hyperpronation |
DDx
- Colon cancer |
- Diverticulitis |
- Prostatitis |
- Salpingitis |
- Renal calculi |
- Appendicitis |
- Psoas abscess |
- Tendon avulsion |
- Muscle contusion |
- Myotendinous strain |
- Femoral bursitis |
- Hip OA |
- Lx disc |
Imaging
- Not usually needed unless red flags (bony pathology, f#, avulsion, OA) |
- Cause of anterior groin pain from GI, GU systems |
- Rule out SCFE if child/adolescent |
- US/MRI for bursitis/ iliopsoas tendinopathy |
Management
- Exercise (hip flex & rotators - psoas inhibition, trunk curl, bum walk)
If abductor weakness/spinal instability consider single leg squats,monster walks, core strenghtening |
- Reassurance and education |
- Cross friction massage |
- Acupuncture |
- Laser therapy |
- Ice |
- Manipulation/mobilisation - LP and Lx |
- STW iliopsoas |
- Avoidance of prolonged hip flex (sitting) |
- Orthotics for hyperpronators |
- LL inequality |
- Steroid injections and Sx if no better |
|
