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Iliopsoas Tendonitis & Snapping Hip

  • Tendinitis

    • probably because something is rubbing on it or tendon is overloaded because of undercoverage/dysplasia and it is stabilizing the head
    • or maybe there is bone spur or calcified labrum rubbing it
  • Internal Snapping Hip Syndrome

    • probably most common cause/indication 
    • this has to be painful to indicate surgery
  • Associated with FAI

    • probably secondary to spur
    • from flexion (>90) to exntesion
    • voluntary
    • asymptomatic in 5%
    • symptomatic
      • conservative treatment
      • PT, injections
    • usually present with normal gait
    • refer snapping to front of hip (lateral you can see (troch), front you can hear it)
    • supine
      • flexion, abduction, and external rotation
      • extension, adduction, and IR
      • reproduce snapping
    • most will have associated intra-articular pathology
    • US
      • injection – have them flex hip, can see it contract, put injection right in there
    • Arthrogram MR
    • Surgical release – Endoscopic

      • contraindications – dysplasia, undercoverage (will become unstable)
      • if you want to be tendon conserving, you have to cut it more proximal
      • for central compartment release
        • under traction
        • usually inflamed tissue
        • extend medial capsulotomy
        • hook probe
        • under tension
    • Aoki, AJSM 2016
      • 25% less volume compared to contralateral side after release
      • 19% less strength in seated hip flexion but not supine compared to contralateral
    • leave the muscle alone because there is bad stuff behind it

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