Iliopsoas Tendinitis Workup

Updated: Jan 16, 2019
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Sherwin SW Ho, MD  more...
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Laboratory Studies

See the list below:

  • Laboratory studies rarely are indicated if diagnosis of iliopsoas tendinitis is certain.

  • If the diagnosis is unclear, a CBC count, erythrocyte sedimentation rate or C-reactive protein, rheumatoid factor, anticyclic citrullinated peptide antibody, antinuclear antibody, and urinalysis are helpful ancillary tests for distinguishing among several other causes of groin pain.


Imaging Studies

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  • Plain radiographs

    • Hip radiographs often are the initial imaging study obtained because diagnosis of iliopsoas tendinitis may not be demonstrated clearly.

    • A pelvic anteroposterior radiograph and frog leg lateral radiograph of the affected hip often are adequate initial studies.

    • Radiographs typically are normal in cases of iliopsoas tendinitis, but may demonstrate other bony pathology, which may contribute to the patient's symptom complex.

  • Ultrasonography

    • Ultrasonography has been used more frequently as a noninvasive diagnostic adjunct in the diagnosis of muscle-tendon injuries. Demonstration of a thickened tendon is the usual finding. [1]

    • Ultrasonography may demonstrate an excessive amount of fluid in the iliopsoas bursa consistent with iliopsoas bursitis, which may be either a primary or secondary problem.

    • Remember that ultrasonography is highly user-dependent and may not be the optimal test at institutions with personnel who are unfamiliar with ultrasonography use for this type of examination.

  • MRI

    • MRI currently is the criterion standard in the ancillary evaluation of painful conditions of the hip and pelvis, particularly because many anatomical structures may be the origin of the pain. In a recent study of 19 endurance athletes with groin pain and an established clinical diagnosis, MRI was shown to reclassify 32% of the hips to a different etiology for the groin pain. These diagnoses included iliopsoas muscle tears and iliopsoas tendinitis.

    • In evaluating musculotendinous injury, the spin-echo T2-weighted images demonstrate increased signal intensity associated with swelling and inflammation. However, in hemorrhage associated with a more severe musculotendinous injury, both the T1-weighted images and T2-weighted images depict a high-signal intensity.

    • In peritendinitis evaluation, increased fluid in the peritendinous tissue is detected on the spin-echo T2-weighted images or short T1 inversion recovery (STIR) sequence as a focus of high-signal intensity surrounding a normal tendon.

    • On the other hand, tendinosis is demonstrated on the spin-echo T1-weighted images as an area of higher signal intensity within the tendon associated with myxoid degeneration or angiofibroblastic proliferation. The spin-echo T2-weighted images may show an abnormal signal (usually less than that seen on the T1-weighted images) or a normal signal.



See the list below:

  • Lidocaine challenge test

    • Lidocaine challenge test may be performed in a challenging case of iliopsoas tendinitis where cause of pain is unclear.

    • Utilizing an anterior approach through the femoral triangle, and under ultrasonographic guidance, an interventional radiologist or orthopedic surgeon attempts to bath the iliopsoas tendon with 1% lidocaine. In general, 10 mL of lidocaine administered via a 25-gauge spinal needle is adequate for local anesthesia.

    • Relief of symptoms after injection confirms diagnosis.