non-arthroplasty iliopsoas impingement in athletes: a narrative literature review

Abstract

Introduction: Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options. Methods: We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement. Results: Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The ‘C-sign’ and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results. Conclusions: Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.

Multiple iliopsoas tendons: a cadaveric study and treatment implications for internal snapping hip syndrome

“…Furthermore, arthroscopic surgeons should be aware of the possibility of three iliopsoas tendons as these are by no means infrequent (14.3% in this study). Care must be taken when searching for additional tendons, however, due to the proximity of the medial femoral circumflex artery to the medial edge of the psoas tendon sheath [6,15].…”

“…Although initial management of ISHS is conservativeconsisting of analgesia, physiotherapy and life-style modification-tenotomy may be indicated in cases of persistent debilitating pain [5,6]. This procedure, however, is only considered in the most severe cases due to previous findings of post-operative hip flexion weakness, atrophy of the remanent iliopsoas, and concerns regarding gross instability of the hip joint following iliopsoas tenotomy [5,[7][8][9].…”

Anatomical variation of the Psoas Valley: a scoping review

“…Philippon et al recognized the anterior labral sulcus as a concave impression on the anterior rim of the acetabulum, and also note the location of the iliopsoas tendon anteriorly [4]. Consistent with these factors, it is likely that iliopsoas impingement, rather than femoroacetabular impingement (FAI), is the key player in the development of focal labral tears in this location [5,6].…”

Anatomical Variation of the Psoas Valley: A Scoping Review

“…Philippon et al recognised the anterior labral sulcus as a concave impression on the anterior rim of the acetabulum, and also note the location of the iliopsoas tendon anteriorly [4]. Consistent with these factors, it is likely that iliopsoas impingement, rather than femoroacetabular impingement (FAI), is the key player in the development of focal labral tears in this location [5,6].…”