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PubMed1998

Iliopsoas bursitis and tendinitis. A review.

This review examines the diagnosis and management of iliopsoas bursitis and/or tendinitis. It is a relatively uncommon and unrecognised cause of anterior hip pain and anterior snapping hip. In view of its pathology, iliopsoas bursitis might be better referred to as iliopsoas syndrome. It can usually be diagnosed by history and physical examination, though real time ultrasound may be useful in confirming the diagnosis. Magnetic resonance and computerised tomography imaging have limited roles in its diagnosis, but may identify other pathology or surgical lesions. Nonoperative management has not been well established. Surgical management does not guarantee treatment success. There is a need for further research into both diagnostic and treatment options for those patients with iliopsoas bursitis/tendinitis.

Bursitis↗
PubMed2002

A preliminary study on the reliability of physical performance measures in older day-care center clients with dementia.

BACKGROUND: Decline in physical functional ability is an intrinsic component of the dementia syndrome. Reductions in muscle mass and strength represent a major factor in the loss of functional ability Although resistance exercise has been studied as a method for maintaining/recovering function in populations of frail older adults, people with dementia have been systematically excluded because of uncertainty about the reliability of outcome measurements. OBJECTIVE: The purpose of this study was to determine the test-retest reliability of a battery of established performance-based measures of strength and function among subjects with dementia. SETTING: A hospital-affiliated adult day-care facility. SUBJECTS: Twelve of 28 older subjects with dementia of various etiologies were available for two assessments prior to implementation of a resistance-exercise intervention. METHODS: Subjects underwent an assessment of lower extremity strength and physical function consisting of two recorded trials of bilateral isometric strength of the knee extensor, hip flexor, and dorsiflexor muscles, as well as hand grip strength; repeated chair stands, evaluation of usual- and maximal safe-gait speed over a 6-m course, and the Timed-Up-and-Go Test. The entire assessment was repeated approximately 1 week later. An average of the trials for each measurement was computed for each of the two assessment periods, and intraclass correlation coefficients (ICCs) for these paired measurements were estimated using STATA. RESULTS: ICCs ranged from .56 for left iliopsoas to .77 for left dorsiflexors among the strength measures whereas measures of function ranged from .80 for number of steps in usual gait to .95 for time of fast gait. CONCLUSIONS: Performance-based measures of strength and function can be reliably assessed in older people with dementia, although measures of function appear to be more reliable than measures of strength.

Activities of Daily Living↗
PubMed1999

[Space-occupying lesions in the iliopsoas space: a challenge in the Department of Internal Medicine].

Mass lesions in the iliopsoas compartment (MLIPC) are uncommon in patients in departments of medicine and their incidence and etiologies are unclear. In a prospective study we diagnosed various MLIPCs in 7 patients during a 10-year period, representing 0.03% of admissions. Symptoms included abdominal or flank pain (4 cases), pain along the thigh (5), diminished psoas muscle strength (2), fever (2), and hypotension (1). MLIPC was suspected on clinical grounds in 5 cases. In all cases the diagnosis was established by computed tomography (CT). Tissue was sampled by needle biopsy in 4 and on surgery in 1. MLIPCs were caused by hemorrhage (2), infection (2), neoplasia (2) and inflammatory mass (1). Often MLIPCs are life-threatening so their timely diagnosis by early CT scan is important.

Adult↗
PubMed1984

Iliopsoas transfers in children with myelomeningocele.

Thirty-two paralytic hips in seventeen children with myelomeningocele and a neural deficit at the fourth lumbar level were treated with iliopsoas transfers. Four to fourteen years later, all of the hips were reduced and nineteen had a center-edge angle of more than 25 degrees. This result was more consistent in the hips of the ten patients who had had a combined varus osteotomy and transfer. All but three of the transferred muscles were active: twenty-one had abduction and fifteen had extension against gravity. We concluded that the procedure has value, but that it does not produce a normal hip.

Adolescent↗
PubMed1988

Stabilisation of the hip in myelomeningocele. Comparison of posterior iliopsoas transfer and varus-rotation osteotomy.

Patients with myelomeningocele who had had surgery to stabilise the hip were reviewed; the results of the 106 operations in 88 patients were assessed. In the earlier part of the series there were 55 children who had 64 iliopsoas transfers; later in the series 33 children had 42 varus-rotation osteotomies combined with adductor tenotomy, anterior obturator neurectomy and psoas division. The technical results of both operations were satisfactory: following iliopsoas transfer only 19% of the hips were either dislocated or subluxated; the corresponding figure for the osteotomy was 12%. Thus varus-rotation osteotomy with psoas division, adductor tenotomy and anterior obturator neurectomy was at least as effective in stabilising the hip as iliopsoas transfer. Nevertheless 80% of the latter and 61% of the osteotomy patients relied on wheelchairs for mobility.

Child↗
PubMed2003

Can neuromuscular strength and function in people with dementia be rehabilitated using resistance-exercise training? Results from a preliminary intervention study.

BACKGROUND: Neuromuscular weakness is a prominent symptom among people with central nervous system disorders, such as dementia, typically leading to disability in activities of daily life. We sought to evaluate the potential of resistance exercise to improve neuromuscular strength and function in the lower extremities among community-dwelling people with dementia. METHODS: Twenty-eight subjects, aged 70-88 years and with an average Mini-Mental State Examination score of 17.8 +/- 7.2, were recruited from a population of adult daycare facility users. Subjects underwent pre- and postintervention assessment of strength and physical function consisting of determination of bilateral maximum strength of the knee extensor, hip flexor, dorsiflexor muscles, and handgrip; and evaluation of lower-extremity function based on repeated chair stands and gait speed. The intervention consisted of moderate-intensity progressive resistance training of the hip extensors, abductors, knee extensors and flexors, and dorsiflexors using the Theraband resistance system for up to 3 days weekly over a 6-week period. RESULTS: Subjects completed an average of 11.4 +/- 2.5 exercise sessions. Among those who exercised at least twice per week (> or = 12), they improved an average of 15.6% in quadriceps strength, 10.1% in handgrip strength, 22.2% in sit-to-stand (STS) time, 9.9% in usual gait time, 5.4% in fast gait time (p =.03), and 14.0% in the timed-up-and-go (TUG) test. CONCLUSIONS: Subjects demonstrated improvements in some areas of muscular capacity (quadriceps and handgrip) and most tests of lower-extremity function (STS, gait, TUG), yet declines in other areas (dorsiflexion and iliopsoas strength). Although strength or functional deficits in all domains were not remediable, these results suggest the potential of a resistance-exercise intervention of longer duration and/or greater intensity to produce beneficial effects on the neuromuscular functioning of people with dementia.

Aged↗
PubMed1995

Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome.

PURPOSE: To evaluate the efficacy of both iliopsoas bursa imaging and therapeutic injections for determination of the cause of pain in patients with internal snapping hip syndrome. MATERIALS AND METHODS: Twelve patients underwent iliopsoas bursa imaging. One patient underwent the procedure bilaterally and five underwent repeated studies for a total of 21 studies. Eight patients also received therapeutic injections after bursa imaging. RESULTS: Abnormal motion of the iliopsoas musculotendinous unit that occurred synchronously with the snap was revealed in 15 of the 21 studies. Four studies revealed additional information that contributed to symptoms. Eight patients received therapeutic injections with relief of symptoms that ranged from 2 weeks to 2 years. CONCLUSION: Iliopsoas bursa imaging is a simple, rapid, and reproducible method with which abnormal iliopsoas tendon motion can be documented in patients with internal snapping hip syndrome and is also useful for diagnosis of other causes of atypical hip pain. Therapeutic injection into the iliopsoas bursa may delay or obviate surgery.

Adolescent↗
PubMed1993

Cystic enlargement of the iliopsoas bursa causing venous obstruction as a complication of total hip arthroplasty. A case report.

The authors report an unusual complication of total hip arthroplasty. A patient developed significant swelling and discomfort in the left lower extremity 4 1/2 years following a left total hip arthroplasty. Magnetic resonance imaging and venography demonstrated a large intrapelvic mass compressing the external iliac vein. An arthrogram revealed a cystic cavity consistent with an iliopsoas bursa in communication with the hip pseudocapsule. Two aspirations of the bursa led to resolution of the cystic enlargement and symptoms. An enlarged iliopsoas bursa should be considered in the differential diagnosis of hip pain or extremity swelling after total hip arthroplasty.

Adult↗
PubMed1998

Assessment of the flexibility of elite athletes using the modified Thomas test.

AIM: To analyse the modified Thomas test and obtain measures of flexibility for the iliopsoas, quadriceps and tensor fascia lata/iliotibial band. METHOD: The modified Thomas test was used to determine the range of flexibility of 117 elite athletes in tennis, basketball, rowing, and running. RESULTS AND CONCLUSION: The study has provided objective data for a clinical test measuring flexibility of the iliopsoas, quadriceps, and tensor fascia lata/iliotibial band. It is recommended that sufficient flexibility is obtained to perform a specific sport and that asymmetries between limbs are addressed.

Biomechanical Phenomena↗
PubMedDate not supplied

Iliopsoas bursitis: diagnosis by MRI.

Iliopsoas bursitis is an unusual cause of hip pain. The condition may be due to athletic activity or may be secondary to a variety of inflammatory etiologies. An understanding of the anatomy and biomechanics of this structure is necessary to ensure prompt and appropriate radiologic diagnosis and clinical treatment. We report two cases of iliopsoas bursitis diagnosed with MRI and review the anatomy, pathophysiology, and treatment of this condition.

Adrenal Cortex Hormones↗
PubMed1992

Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty.

In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA.

Abdominal Neoplasms↗
PubMed2004

Primary synovial osteochondromatosis of the hip: extracapsular patterns of spread.

OBJECTIVE: To identify patterns of extracapsular extension of synovial osteochondromatosis of the hip. DESIGN AND PATIENTS: Seven cases of synovial osteochondromatosis of the hip were retrospectively reviewed. Imaging performed included conventional radiography ( n=7), arthrography ( n=1), CT ( n=3) and MR imaging ( n=3). Disease extent on imaging was assessed for each patient and the presence of intra-articular effusion, capsular abnormality and osteochondral bodies recorded. The presence and distribution of extra-articular spread was also assessed and correlated with the surgical findings. In all cases diagnosis was confirmed by biopsy, with all patients undergoing tumor resection with or without synovectomy. RESULTS: In five cases (5/7) disease extended beyond the hip capsule, while the remaining two cases (2/7) were confined to the hip joint. These findings were confirmed at surgery. Two distinct patterns of extracapsular spread were identified. The first pattern, noted in three cases, involved tumor extension along iliopsoas. The second pattern, noted in five cases, involved tumor extension along the obturator externus fat plane. In three cases both patterns were present. CONCLUSIONS: Extra-articular spread of synovial osteochondromatosis is common. Patterns of extra-articular spread may be predictable based on involvement of recognized periarticular bursae of the hip joint. Bursal patterns of extra-articular spread include extension into the iliopsoas bursa as well as communication along the obturator externus bursa of the hip.

Adult↗
PubMed1987

Teardrop bladder: demonstration by magnetic resonance imaging.

Teardrop deformity of the urinary bladder and ureteral deviation may be caused by iliopsoas hypertrophy. Magnetic resonance imaging (MRI) findings in such a case are described, and the potential advantages of MRI in evaluating the pelvis are discussed.

Adult↗
PubMed2002

Surgical correction of the snapping iliopsoas tendon in adolescents.

BACKGROUND: There have been very few reports regarding symptomatic snapping of the iliopsoas tendon, and none of those reports have dealt exclusively with an adolescent population. We report our experience with the surgical treatment of this entity in a group of patients who had an average age of fifteen years. METHODS: Nine adolescent patients (eleven hips) underwent fractional lengthening of the iliopsoas tendon at the musculotendinous junction because of persistent painful snapping of the hip. A modified iliofemoral approach to the iliopsoas tendon was used. The diagnosis in all cases was made on the basis of the history and a physical examination. Plain radiographs were made for all patients to rule out an osseous intra-articular loose body. Follow-up consisted of personal interviews and physical examinations performed at least two years postoperatively. RESULTS: Preoperatively, all patients had audible snapping with pain localized to the anterior part of the groin. The average duration of symptoms was 2.3 years. Prior to the onset of symptoms, all but one of the patients had been involved in competitive athletic activities. Postoperatively, all patients were able to return to the preoperative level of activity without subjective weakness. The average duration of postoperative follow-up was four years. Hip-flexion strength was noted to be nearly equal to that on the contralateral side. All patients reported that they would have the operation again under similar circumstances. One patient had recurrent snapping but stated that it was less frequent and less painful than the preoperative snapping. Two patients had transient sensory loss in the anterolateral aspect of the thigh. CONCLUSIONS: We conclude that fractional lengthening of the iliopsoas tendon at the musculotendinous junction is an effective and safe approach for adolescent patients with persistent symptomatic snapping of the iliopsoas tendon that is unresponsive to conservative measures.

Adolescent↗