Hip

Iliopsoas Bursitis

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

  • See Also
  1. Groin Injuries in Athletes
  • 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
  • Mechanism
  • Sports with hip flexor use
  1. Soccer
  2. Ballet
  3. Uphill Running
  4. Hurdling
  5. Jumping
  • 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
  • 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
  • Associated Conditions
  1. Snapping Hip Syndrome
  • 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
  • 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
  • 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]