ILIOPSOAS-RELATED GROIN PAIN AND SYMPTOMS
The iliopsoas muscle and tendon can have tendinitis, strain, partial tear, snapping.
Iliopsoas muscle is comprised of two muscles, psoas major and iliacus.
Insertion: Lesser tuberosity of the femur.
Nerve: Lumbar plexus
Insertion: Lateral side of the tendon of the psoas major and lesser tuberosity.
Nerve: Femoral nerve and lumbar plexus.
Action of the Iliopsoas:
Strongest flexor of the hip. External rotation of the hip.
Testing: Full hip flexion with the knee flexed.
Iliopsoas tendinitis is an inflammation of the iliopsoas tendon and surrounding tendon.
Iliopsoas muscle can be injured during kicking activities. Acute trauma and repetitive hip flexion or external rotation of the thigh.
Sports: Football (soccer), dancing, ballet, rowing, running, track and field, gymnastics.
Chronic anterior hip/groin pain. Sometimes poorly localized deep ache. Sometimes sensation of snapping/clicking in the groin.
Two main signs, tenderness during palpation and iliopsoas test and stretch.
Palpation of the iliopsoas tendon just below the inguinal ligament, lateral to the femoral artery and medial to the sartorius muscle can detect tenderness in thin patient.
Tightness on iliopsoas stretch performed in the Thomas test position. Exacerbation on resisted hip flexion in the stretch position. The strength testing can be performed in supine of sitting position. The hip is maximally flexed, then the thigh is extended against patient maximal resistance.
In addition, in case of snapping hip, a snapping sensation can be felt as the iliopsoas tendon shifts over the iliopectineal eminence, femoral head or lesser trochanter. The snapping can be reproduced by extending and adducting the hip from the flexed and abducted position.
Examination of the lumbar spine is important.
Ultrasonography durign hip motion may demonstrate the tendon subluxation.
Other causes of groin pain including Abdominal wall-related groin pain, Pubic symphysis-related groin pain, Proximal rectus femoris strain, Labral tears, Stress fractures, Neuropathy, Hip avulsion fractures, Osteonecrosis of the hip, Tumors.
(Iliopsoas tendinitis can be due to the protrusion of a hip prosthetic implant.)
After a short period of rest and pain killers, the treatment of iliopsoas-related groin pain is based on active rehabilitation.
Identification and reduction of the sources of increased load on the pelvis. Soft tissue therapy and muscle stretch. Muscle strengthening. Improvement of lumbopelvis stability. Exercices must be performed without pain. Return to activity must be progressive based on the clinical assessment.
Some people proposed to do a corticosteroide subfascial injection. Usually, radioguided.
Arthroscopic release is proposed in snapping of the tendon after conservatire treatment.
Endoscopic treatment of snapping hips, iliotibial band, and iliopsoas tendon.
Ilizaliturri VM Jr, Camacho-Galindo J.
Sports Med Arthrosc. 2010 Jun;18(2):120-7. Review.
A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes.
Machotka Z, Kumar S, Perraton LG.
Sports Med Arthrosc Rehabil Ther Technol. 2009 Mar 31;1(1):5.
PMID: 19331695 [PubMed] Free PMC Article
The snapping iliopsoas tendon: new mechanisms using dynamic sonography.
Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ.
AJR Am J Roentgenol. 2008 Mar;190(3):576-81.
PMID: 18287424 [PubMed - indexed for MEDLINE] Free Article
Treatment of longstanding groin pain in athletes: a systematic review.
Jansen JA, Mens JM, Backx FJ, Kolfschoten N, Stam HJ.
Scand J Med Sci Sports. 2008 Jun;18(3):263-74. Epub 2008 Apr 6. Review.
Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes.
Anderson SA, Keene JS.
Am J Sports Med. 2008 Dec;36(12):2363-71. Epub 2008 Aug 12.
Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections.
Adler RS, Buly R, Ambrose R, Sculco T.
AJR Am J Roentgenol. 2005 Oct;185(4):940-3.
PMID: 16177412 [PubMed - indexed for MEDLINE] Free Article
Iliopsoas bursitis and tendinitis. A review.
Johnston CA, Wiley JP, Lindsay DM, Wiseman DA.
Sports Med. 1998 Apr;25(4):271-83. Review.