Iliopsoas Tendonitis

Introduction

Iliopsoas tendonitis also referred to as snapping hip syndrome, is an inflammation of the iliopsoas tendon or the surrounding area. The iliopsoas is the hip flexor tendon located over the front of the hip socket. The term snapping hip describes the sound made, a snap or click, that occurs with certain hip movements including flexion, extension, and rotation of the hip.

The condition usually occurs due to trauma or overuse from repetitive hip flexion or bending of the hip joint. Iliopsoas tendonitis may be acute or chronic depending on the duration of symptoms.

Causes

The common causes of iliopsoas tendonitis include:

An acute injury or
Overuse injury

These injuries may occur due to activities such as:

ballet
dancing
cycling
resistance training
gymnastics
running (particularly uphill)
soccer

Signs and Symptoms

The common signs and symptoms of iliopsoas tendonitis include:

Initial Symptoms

Anterior hip or groin pain associated with specific sports-related activities, such as running, jogging, or kicking
Audible snap or click in the hip or groin

Progressive Symptoms

Hip or groin pain during simple day-to-day activities
Pain that radiates down from the anterior thigh toward the knee
Pain even at rest

Diagnosis

Iliopsoas tendonitis is diagnosed through a review of your medical history and a detailed physical examination of your abdomen, hip, and groin.

Your doctor will perform the following:

Inspection of the hip at rest and with flexion.
Functional test: You will be asked to bend and rotate your hip joint.
Palpation of the hip joint through touch to assess for any swelling or unusual tenderness in your hip joint.
You may also be asked to sit with your knees extended with subsequent elevation of the heel on the affected side.
Imaging tests such as x-rays, ultrasound, and MRI scans of the hip and pelvis may also be performed to confirm a diagnosis of iliopsoas tendonitis.

Lidocaine Challenge Test

This test is performed if the cause of your hip or pelvic pain is not quite clear. In this test, your doctor will inject 1% lidocaine into your hip joint, targeting the iliopsoas tendon under ultrasound guidance. If you experience relief from the hip pain this confirms a diagnosis of iliopsoas tendonitis.

Treatment

Treatment for iliopsoas tendonitis may include:

Physical therapy and stretching exercises
Pain relief medications
Injection of a corticosteroid with a local anesthetic such as 1% lidocaine under ultrasound
Surgery is only recommended to those who have intense symptoms and more severe psoas tendonitis that fails to respond to a conservative non-invasive therapy.

Surgery for the treatment of iliopsoas tendonitis may involve either a complete release or a partial release of the iliopsoas tendon, meaning that the tendon is either cut completely or partially in order to relieve the pain.

Summary

Iliopsoas tendonitis or snapping hip syndrome is a condition caused by inflammation of the iliopsoas tendon or surrounding structures. It is commonly seen in athletes and dancers due to an acute injury or overuse of the hip joint from repetitive movements during sports, exercise, and ballet. Treatment includes stretching exercises, physical therapy, pain relief medications, and corticosteroid injections. Surgery is only recommended for severe cases of psoas tendonitis that do not respond to conservative measures.