Skeletal Radiology

, Volume 35, Issue 8, pp 565–571 | Cite as

Sonography of the iliopsoas tendon and injection of the iliopsoas Bursa for diagnosis and management of the painful snapping hip

  • Donna G. BlankenbakerEmail author
  • Arthur A. De Smet
  • James S. Keene
Scientific Article



The purpose of this study was to compare sonographic evaluations of patients referred with suspected snapping of their iliopsoas tendon with the pain relief achieved from anesthetic injection of the iliopsoas bursa, and with the subsequent surgical outcome. This study also assessed the effectiveness of Kenalog injection into the iliopsoas bursa for long-term pain relief.

Patients and methods

Dynamic and static sonography was performed in 40 patients with clinically diagnosed snapping hips. The iliopsoas bursa was injected with Bupivicaine and Lidocaine in the first 22 patients, and an additional 1 ml Kenalog-40 was added to this mixture in the last 18 patients. We compared the static and dynamic sonographic findings with change in the patients’ level of pain at 2 days after anesthetic injection. The sonographic findings and response to anesthetic injection were also compared to the response to Kenalog injection and the results of any subsequent surgery.


Static sonography of the iliopsoas tendon was normal in 38 patients, and detected iliopsoas bursitis in one patient and iliopsoas tendinopathy in another. Snapping of the iliopsoas tendon was observed using dynamic sonography in 9 of the 40 patients. Following anesthetic injection of the iliopsoas bursa, 29 patients had complete or partial pain relief, and 11 patients had no pain relief. Eight of the nine patients with a snapping iliopsoas tendon had complete or partial pain relief from the bursal injection. Twelve of the 29 patients with pain relief after anesthetic injection later had an arthroscopic iliopsoas tendon release, and all of these 12 patients had a good postoperative result. Of the 18 patients who had Kenalog-40 injected into the iliopsoas bursa and did not have iliopsoas surgery, 16 had sustained pain relief following the injection.


Patients with groin pain and a clinically suspected snapping iliopsoas tendon can benefit from injection into the iliopsoas bursa even if the snapping tendon is not visualized sonographically. The use of a corticosteroid may provide long-term pain relief, and pain relief after injection is a predictor of good outcome after surgical release of the iliopsoas tendon.


Sonography Hip Iliopsoas Therapeutic/diagnostic injection 


  1. 1.
    Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg 1995;3(5):303–308PubMedGoogle Scholar
  2. 2.
    Schaberg JE, Harper MC, Allen WC. The snapping hip syndrome. Am J Sports Med 1984;12:361–3365PubMedCrossRefGoogle Scholar
  3. 3.
    Idjadi J, Meislin R. Symptomatic snapping hip: targeted treatment for maximum pain relief. Phys Sports Med 2004;32(1):25–31Google Scholar
  4. 4.
    Janzen DL, Partridge E, Logan M, Connell DG, Duncan CP. The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Can Assoc Radio J 1996;47(3):202–208Google Scholar
  5. 5.
    Johnston CAM, Wiley DM, Wiseman DA. Iliopsoas bursitis and tendonitis. Sports Med 1998;25:271–283CrossRefPubMedGoogle Scholar
  6. 6.
    Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings. AJR Am J Roentgenol 2001;176:67–73PubMedGoogle Scholar
  7. 7.
    Wahl CJ, Warren RF, Adler RS, Hannafin JA, Hansen B. Internal coxa saltans (snapping hip) as a result of overtraining. Am J Sports Med 2004;32(5):1302–1309CrossRefPubMedGoogle Scholar
  8. 8.
    White RA, Hujghes MS, Burd T, Hamann J, Allen WC. A new operative approach in the correction of external coxa saltans. Am J Sports Med 2004;32(6):1504–1508CrossRefPubMedGoogle Scholar
  9. 9.
    Lyons JC, Peterson LF. The snapping iliopsoas tendon. Mayo Clin Proc 1984;59:327–329PubMedGoogle Scholar
  10. 10.
    Cardinal E, Buckwalter KA, Capello WN, Duval N. US of the snapping iliopsoas tendon. Radiology 1996;198:521–522PubMedGoogle Scholar
  11. 11.
    Vaccaro JP, Sauser DD, Beals RK. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome. Radiology 1995;197:853–856PubMedGoogle Scholar
  12. 12.
    Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990;18:470–474PubMedCrossRefGoogle Scholar
  13. 13.
    Brignall CG, Stainby GD. The snapping hip: treatment by Z-plasty. J Bone Joint Surg Br 1991;73:253–254PubMedGoogle Scholar
  14. 14.
    Beals RK. Painful snapping hip in young adults. West J Med 1993;49:481–482Google Scholar
  15. 15.
    Rezig R, Copercini M, Montet X, Martinoli C, Bianchi S. Ultrasound diagnosis of anterior iliopsoas impingement in total hip replacement. Skeletal Radiol 2004;33:112–116CrossRefPubMedGoogle Scholar
  16. 16.
    Adler RS, Buly R, Ambrose R, Sculco T. Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. AJR Am J Roentgenol 2005;185:940–943CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • Donna G. Blankenbaker
    • 1
    Email author
  • Arthur A. De Smet
    • 1
  • James S. Keene
    • 2
  1. 1.Department of RadiologyUniversity of Wisconsin Medical SchoolMadisonUSA
  2. 2.Department of Orthopedics and RehabilitationUniversity of Wisconsin Medical SchoolMadisonUSA

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