Iliopsoas Bursitis

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Original Editors - Andrea Nees

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Search Strategy

Databases: Pubmed
Keywords: Iliopsoas bursitis, bursitis, physiotherapy, groin pain, physical therapy

Definition/Description

For the definition of bursitis: See Bursitis
A bursitis is an inflamed bursa. The inflammation can be a result of friction from the overlying tendons. A bursa is mostly flattened and is filled with a thin layer of synovial fluid. It appears for example at a junction of a tendon on the bone. The iliopsoas bursa separates the muscle or tendon from bone and facilitates movement by reducing friction between the anterior hip capsule and the iliopsoas. [7, 3] The iliopsoas bursitis is one of the affections related to anterior hip pain.
 

Clinically Relevant Anatomy

The iliopsaos bursa is the largest bursa of the human body and is bilaterally present in 98% of adults. This bursa is bounded by the musculotendinous junction of the M. iliopsoas (anteriorly) and by the fibrous capsule of the hip (posteriorly). It extends from the inguinal ligament superiorly to the lesser trochanter inferiorly and is flanked by the femoral vessels (medially) and the femoral nerve (laterally). [2] The bursa is always collapsed, when in healthy condition. In some situations the bursa is enlarged, and contains fluid. When enlarged, it may cause a variety of symptoms such as pain, and immobility. [8, 3]

Epidemiology /Etiology

Iliopsoas bursitis is mainly caused by:
- Rheumatoid arthritis
- Acute trauma
- Overuse injury

Iliopsoas bursitis is commonly seen in individuals participating in:
- Strength training
- Rowing
- Uphill running
- Competitive track and field

This kind of bursitis mainly affects young adults. It occurs slightly more often in women than men. [3](Level of evidence: A1)

Characteristics/Clinical Presentation

- Pain is generally felt in the groin, anterior part of the thigh, knee and leg
- Pain develops during walking or specific movements like crossing the legs
- Pain is increased when acting weight-bearing activities, putting on socks and shoes, or rising from a chair. [4]
- The pain is worse by hip movements and relieved by rest. [3]

Differential Diagnosis

Distension can be caused by several joint diseases:
- Osteoarthritis
- Rheumatoid arthritis
- Avascular necrosis
- Pigmente villonodular synovitis
- Synovial chondromatosis
- Gout
- Chondrocalcinosis
- Trauma
- Lupus erythematodes
- Pyogenic infection
[2]
Differential diagnosis of anterior hip pain by anatomical structure:
- Joint
   o Osteoarthritis
   o Inflammatory synovitis
   o Loose bodies
   o Infection (septic joint)
   o Crystal-induced synovitis (gout)
   o Labral tears
- Bone
   o Femur
      Stress fracture
      Avascular necrosis of femoral head
      Bone tumour
      Infection

   o Pelvis
      Hip fracture
      Stress fracture
      Osteitis pubis
- Muscle, endon, bursa
   o Iliopsoas bursitis and tendinitis
   o Iliopsoas strain
   o Retus femoris strain
   o Tight iliotibial band
- Vasculature
   o Aneurysm
   o Arteriovenous malformation
- Pelvic mass
   o Gastrointestinal causes (e.g. hernia)
   o Genitourinary causes (e.g. ureteral stone)
- Nerve
   o Obturator nerve entrapment
   o Myalgia paraesthetica
   o Referred from lumbar spine (L1, L2)
 

Diagnostic Procedures

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Outcome Measures

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Examination

- Tenderness to palpation can be found distal to the midpoint of the inguinal ligament in the femoral triangle
- There is a limitation in ROM according to a NIET-CAPSULAIR patron
- Exorotation is painful and has a soft EINDGEVOEL
- Flexion is lightly painful at the end of ROM
- Sometimes pain can be felt at the end of ROM when extension or adduction UITGEVOERD WORDT.
- The most painful movement is adduction with the hip in flexion.
- There’s no weakness of muscles.
- A palpable and/or audible snap can be present [3](level of evidence: A1)
[4]

Medical Management

The patient can take anti-inflammatory medications. There could be performed aspiration and corticosteroid injections of the bursa for persistent pain symptoms. [1]
If physical therapy is unsuccessful, a corticosteroid injection could be the next line of intervention.Surgery is rarely. [3]
 

Physical Therapy Management

The treatment includes stretching of the hip flexor muscles. After that a strengthening program (for hip rotators) can be followed.
Stretching exercises (involving hip extension) performed for 6 to 8 weeks alleviate the symptoms. [3] (Level of evidence: A1)
 

See more exercises on Therapy exercises for the hip

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

1. Parziale J.R., O’Donnell C.J , Sandman D.N., Iliopsoas Bursitis, Am. J. Phys.Med. Rehabil. Vol 88, No.8, August 2009
2. Van de Perre S., Vanwambeke K., Vanhoenacker F.M., De Schepper A.M., Posttraumatic iliopsoas bursitis, JBR-BTR, 2005, 88:154-155
3. Johnston C.A.M., Wiley J.P., Lindsay D.M., Wisemand D.A., Iliopsoas bursitis and tendinitis (a review), Sports Med, april 1998; 25 (4): 271 – 283 (Level of evidence: A1)
4. Ombregt L., Bisschop P., ter Veer H.J., Van de Velde T., A System of Orthopaedic Medicine. 1999.