Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

8. Groin Pain Etiology: Hip- Referred Groin Pain
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Iliopsoas bursitis may occur in internal snapping hip syndrome with
or without the presence of an audible snap (see Snapping Hip Syndrome
above). Due to either acute or repetitive trauma from the recurrent
dragging of the tendon over the lesser trochanter, AIIS, or iliopectineal
eminence, the bursa between the tendon and the pelvic brim becomes
inflamed. Patients report a history of anterior hip or groin pain exacerbated
by flexion and extension of the hip. Although most commonly
associated with an audible snap, up to 31 % of patients have no history
of snapping or popping.
Physical Exam Patients have focal tenderness to palpation over the
lateral trochanter. The Ober test is used to evaluate tightness of the IT
band, which is thought to be the cause of the problem. The patient lies on
his/her contralateral side, the affected leg is extended and allowed to fall
behind the patient; inability to adduct beyond the midline is considered a
positive test [ 23 ].
Patients with iliopsoas bursitis present with anterior hip or groin pain,
exacerbated by flexion or extension of the hip. Tenderness to palpation
over the course of the iliopsoas tendon deep in the femoral triangle is
common, but not universal, and when seen is considered pathognomonic
for the process.
Diagnostic Exams X-ray and ultrasound are not sensitive or specific
for any of the bursitis conditions around the hip. Occasionally,
calcification may be present in the bursa, which indicates chronic
inflammation and calcium deposition. MRI does have some role, as it is
the most sensitive and specific for these conditions; however, diagnosis
of bursitis is mostly clinical, and confirmatory imaging is not usually
required.
Appropriate Treatment/Referral With all bursitis, the mainstay of
treatment is NSAID therapy and physical therapy for stretching and
strengthening. Corticosteroid injection may be performed with or
without the use of ultrasound guidance in greater trochanteric bursitis;
for iliopsoas bursitis, ultrasound guidance is required due to the proximity
to neurovascular structures. In the event that conservative treatment is
unsuccessful, iliopsoas tenotomy or surgical lengthening of the IT band
may be considered.