Hip Pain - Iliopsoas Bursitis: Identifying Causes, Symptoms, and Diagnosis with Ultrasound Scans – Benefits of Ultrasound Guided Injection

Iliopsoas bursitis, also known as iliopectineal bursitis, is a condition characterised by inflammation of the ilipectinal bursa. Located between the iliopsoas muscle and the hip joint, this bursa acts as a cushion to reduce friction during hip movement. When inflamed, it can cause significant discomfort and interfere with daily activities. This condition often coexists with osteoarthritis (OA), creating a complex relationship between joint degeneration and bursal inflammation.

In many cases, ultrasound guided injections provided immediate and sustained relief, helping patients manage pain and regain mobility.

Understanding Iliopsoas Bursitis

Iliopectinal bursitis is primarily triggered by osteoarthritis; however, can be triggered in athletes with acute injuries and overuse.

An injury to the bursa can arises from acute or chronic trauma experienced during sporting activities, with bursitis typically resulting from numerous small traumas due to intense hip flexion and extension. This condition is often observed in individuals engaged in strength training, rowing, uphill running, and competitive track and field events.

Clinical Presentation of Iliopsoas Bursitis

Pain:

• Situated in the front and inner side of the thigh

• Extending to the knee, leg, and lower back

• Occurs during walking or certain actions such as crossing the legs

• Provoked by hip flexion, both resisted and passive

• During internal rotation or passive hyperextension

• Intensified when engaging in activities

• Eased by resting

Symptom:

-Tenderness in proximal part of the quadriceps muscles

- A clicking & snapping sensation at the front of the hip

- Stiffness or pain following periods of rest or in the morning

Role of Ultrasound in Diagnosing Iliopsoas Bursitis

Ultrasound scan is a non-invasive imaging technique that uses sound waves to produce detailed images of the body's soft tissues. It is particularly useful for diagnosing iliopsoas bursitis.

Advantages of Ultrasound

1. Real-Time Imaging: Allows dynamic assessment of the hip joint.

2. High Resolution: Provides detailed images of the iliopsoas bursa, surrounding muscles (iliopsoas), and adjacent structures like the hip joint and nerves.

3. No Radiation: Unlike X-rays or CT scans, ultrasound does not use ionizing radiation, making it a safer option for repeated examinations.

4. Cost-Effective: Generally less expensive than other imaging modalities like MRI.

Ultrasound can detect Bursal Fluid, Thickened Bursa, Muscle Inflammation and Adjacent Nerve Compression.

Ultrasound-Guided Injections for Pain Relief

Ultrasound-guided injections involve using ultrasound imaging to accurately place medication, directly into the inflamed iliopsoas bursa. This improves accuracy, reduces complications, and enhances the therapeutic effect compared to blind injections.

Benefits

1. Accuracy: Ultrasound guidance ensures precise delivery of medication to the affected area.

2. Efficacy: Targeted injections can provide significant pain relief and reduce inflammation.

3. Safety: Minimizes the risk of complications by avoiding surrounding structures.

Conclusion:

Ultrasound guidance significantly improves the accuracy and safety of injections for iliopsoas bursitis. By using real-time imaging, ultrasound allows the healthcare provider to precisely visualize the needle as it approaches the inflamed bursa.

This minimizes the risk of injecting surrounding structures like nerves or blood vessels, leading to a reduced risk of complications and improved therapeutic outcomes. Supported by scientific evidence, ultrasound-guided injections have proven to be a highly effective and safe alternative to traditional blind or landmark guided injections, offering significant benefits for patients suffering from pain.

References:

1. Center for Devices and Radiological Health. (2024, January 12). Ultrasound Imaging. U.S. Food and Drug Administration. https://www.fda.gov/radiation-emitting-products/medical-imaging/ultrasound-imaging

2. Corvino, A., Venetucci, P., Caruso, M., Tarulli, F. R., Carpiniello, M., Pane, F., Sabatino, V., Franzese, R., Catalano, O., Corvino, F., & Catelli, A. (2020). Iliopsoas bursitis: The role of diagnostic imaging in detection, differential diagnosis and treatment. Radiology case reports, 15(11), 2149–2152. https://doi.org/10.1016/j.radcr.2020.08.036

3. Sahr, M. E., Endo, Y., Sink, E. L., & Miller, T. T. (2023). Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement. Skeletal radiology, 52(7), 1385–1393. https://doi.org/10.1007/s00256-022-04264-6

4. Manske, R. C., Voight, M., Wolfe, C., Page, P., & Bardowski, B. (2024). The Use of Diagnostic Musculoskeletal Ultrasound for the Evaluation of the Iliopsoas in the Anterior Hip: A Guide for Rehabilitation Providers. International Journal of Sports Physical Therapy, 19(12). https://doi.org/10.26603/001c.126334

5. Campbell, D. (2017). MRI vs. Ultrasound: What’s the Difference? Iowaradiology.com. https://info.iowaradiology.com/mri-vs.-ultrasound-whats-the-difference

6. Iliopsoas Bursitis. (2009). Physiopedia. https://www.physio-pedia.com/Iliopsoas_Bursitis

7. Parziale, John R. MD; O'Donnell, Casey J. DO; Sandman, David N. MD. Iliopsoas Bursitis. American Journal of Physical Medicine & Rehabilitation 88(8):p 690-691, August 2009. | DOI: 10.1097/PHM.0b013e3181a9efce