iliopsoas bursitis
iliopsoas bursa
The iliopsoas bursa is deep to the iliopsoas tendon and cushions the tendon from the anterior aspect of the hip joint capsule. The bursa is bordered by the iliopsoas muscle anteriorly, the hip joint capsule posteriorly, the iliofemoral ligament laterally, and the acetabular ligament medially. This is the largest bursa in the body, with dimensions up to 7 cm in length and 4 cm in width.
SIGNS AND SYMPTOMS AND COMMON PRESENTATION
- Most common in young adults
- More common in women than men
- Related to overuse activity
- Pain in the inguinal area that may radiate to anterior thigh and knee
- Complaints of an audible snap
- Tenderness to palpation over the femoral triangle
- Pain with prolonged seated flexion or putting on shoes while seated
- Pain with climbing stairs
- Positive and provocative Thomas test
Clinical test
Snapping hip maneuver:
The therapist places one hand over the inguinal area. With the other hand, the therapist positions the lower extremity into hip flexion, abduction, and external rotation. The lower extremity is then moved into extension. An audible snap and/or palpable snap is considered a positive test.
The therapist places one hand over the inguinal area. With the other hand, the therapist positions the lower extremity into hip flexion, abduction, and external rotation. The lower extremity is then moved into extension. An audible snap and/or palpable snap is considered a positive test.
causes
The three most commonly reported causes are rheumatoid arthritis, acute trauma, and overuse injury. However, acute or chronic occupational trauma and sports injuries are believed to be the cause for the majority of incidences. The condition is more commonly seen in patients who participate in weight training, rowing, uphill running, and competing in track and field.
The bursitis is a result of the iliopsoas tendon causing damage to the underlying bursa secondary to friction. There are two main thoughts in regards to the underlying cause:
The bursitis is a result of the iliopsoas tendon causing damage to the underlying bursa secondary to friction. There are two main thoughts in regards to the underlying cause:
- Repetitive hip hyperextension
- When the hip moves from a position of flexion, abduction, and external rotation to hip extension, the tendon snaps over the bursa.
physical therapy implications
- Encourage rest
- Stretch hip flexors
- Strengthen hip external and internal rotators
- Patient education and activity modification
- Postural corrections
- Correction of muscles imbalance
- NSAIDS
references
Dressendorfer R. Iliopsoas Syndrome. In: Richman S, ed. Ipswich, Massachusetts: EBSCO Publishing; 2011:7p.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. 1998;25(4):271-283.
Images:
http://www.eorthopod.com/sites/default/files/images/hip_anatomy_bursa01.jpg
http://www.aidmybursa.com/_img/iliopsoas-bursitis.jpg
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. 1998;25(4):271-283.
Images:
http://www.eorthopod.com/sites/default/files/images/hip_anatomy_bursa01.jpg
http://www.aidmybursa.com/_img/iliopsoas-bursitis.jpg