Snapping iliopsoas tendon

Last revised by Rohit Sharma on 9 Jan 2024

Citation, DOI, disclosures and article data

Citation:

Skalski M, Sharma R, Knipe H, et al. Snapping iliopsoas tendon. Reference article, Radiopaedia.org (Accessed on 23 Apr 2024) https://doi.org/10.53347/rID-45906

DOI:

https://doi.org/10.53347/rID-45906

Permalink:

https://radiopaedia.org/articles/45906

rID:

45906

Article created:

13 Jun 2016, Matt Skalski ◉

Disclosures:

At the time the article was created Matt Skalski had no recorded disclosures.

View Matt Skalski's current disclosures

Last revised:

9 Jan 2024, Rohit Sharma ◉

Disclosures:

At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.

View Rohit Sharma's current disclosures

Revisions:

10 times, by 7 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Tags:

refs, cases, sports, sports medicine, sports injury, rg_38_3_edit

Synonyms:

Internal snapping hip syndrome

Snapping iliopsoas tendon is one of the external causes of a medial snapping hip and occurs when a portion of the iliopsoas tendon moves abruptly onto the superior pubic ramus leading to a snap.

This typically is a result of a rapid relocation of a portion of the iliopsoas tendon, transiently entrapped anterior and lateral to the portion of the iliacus muscle belly during flexion external rotation and abduction of the femur, onto the superior pubic ramus during returning into the neutral position or less commonly a bifid tendon moving around itself ¹.

Other rare known causes of snapping iliopsoas tendon are snapping over an adjacent paralabral cyst or across the anterior inferior iliac spine (AIIS) in the frog leg position ^1,2.

Radiographic features

Ultrasound

Dynamic ultrasound examination while doing a maneuver to reproduce the snap is often diagnostic ¹.

CT

Typically there is no role for CT in the evaluation of this abnormality, though if abundant in sufficient quantities, iliopsoas bursal fluid is detectable ^ref.

MRI

MRI does not demonstrate dynamic evidence of snapping iliopsoas tendon, however, can be helpful in demonstrating the secondary signs of iliopsoas tendon irritation and adjacent inflammatory changes. If present, this usually includes excess fluid within iliopsoas bursa. Synovial thickening and debris within the iliopsoas bursa, surrounding soft tissue edema, and underlying bone marrow edema pattern may also be seen. Thickening and increased intrasubstance signal of iliopsoas tendon and/or edema within the adjacent iliacus muscle belly could also be encountered.

Treatment and prognosis

This phenomenon is present in approximately 40% of the asymptomatic population, and by itself does not require investigation, although in repetitive this condition can result in iliopsoas tendinopathy ^1,2.

Iliopsoas tendon release or fasciotomy have been used to alleviate pain in those who fail conservative treatment measures.