Ultrasound-Guided Cortisone Injections for Iliopsoas Tendinopathy/Bursitis

 

Introduction

Iliopsoas tendinopathy and iliopsoas bursitis are common causes of anterior hip pain, particularly in individuals who engage in repetitive hip flexion activities such as running, cycling, or dancing. These conditions can significantly impact mobility, causing discomfort during walking, climbing stairs, or even prolonged sitting.

While conservative management often includes rest, physiotherapy, and anti-inflammatory medications, some individuals may experience persistent symptoms requiring targeted interventions. Ultrasound-guided cortisone injections are an option for managing pain and inflammation associated with iliopsoas-related conditions.

This blog explores the anatomy, pathology, symptoms, diagnosis, and treatment options for iliopsoas tendinopathy and bursitis, with a focus on the role of ultrasound-guided cortisone injections.


Anatomy of the Iliopsoas Muscle and Bursa

The iliopsoas is a deep muscle group consisting of the psoas major, psoas minor, and iliacus muscles. It plays a crucial role in hip flexion, stabilisation, and maintaining posture.

  • Psoas Major: Originates from the lumbar spine and inserts onto the lesser trochanter of the femur.
  • Iliacus: Originates from the iliac fossa and joins the psoas major at the iliopsoas tendon.
  • Iliopsoas Tendon: Connects the iliopsoas muscle to the femur, facilitating hip flexion.
  • Iliopsoas Bursa: A fluid-filled sac located between the iliopsoas tendon and the hip joint capsule, reducing friction during movement.

When the iliopsoas tendon is subjected to excessive stress, tendinopathy (degenerative changes) or bursitis (inflammation of the bursa) may develop.

Pathology of Iliopsoas Tendinopathy and Bursitis

Iliopsoas Tendinopathy

Tendinopathy refers to degenerative changes in the tendon due to repetitive strain, overuse, or biomechanical abnormalities. It can occur due to:

  • Repetitive hip flexion (e.g., cycling, running, dancing).
  • Poor biomechanics leading to excessive stress on the tendon.
  • Muscle imbalances causing increased strain on the iliopsoas.

Over time, microtears and collagen disorganisation within the tendon can lead to persistent pain and weakness.

Iliopsoas Bursitis

Bursitis occurs when the iliopsoas bursa becomes inflamed, often due to excessive friction between the tendon and surrounding structures. Common causes include:

  • Overuse injuries from repetitive hip movement.
  • Hip joint abnormalities such as femoroacetabular impingement (FAI) or hip osteoarthritis.
  • Post-surgical irritation following hip replacement or arthroscopy.

Symptoms of Iliopsoas Tendinopathy and Bursitis

Both conditions present with overlapping symptoms, including:

  • Pain in the anterior hip or groin that worsens with movement.
  • Discomfort during hip flexion activities (e.g., climbing stairs, getting out of a chair).
  • Snapping or clicking sensation in the hip.
  • Pain radiating to the thigh or knee in some cases.

Pain is often aggravated by prolonged sitting, walking, or direct pressure over the iliopsoas region.

Diagnosis

A clinician will typically conduct a comprehensive assessment, which includes:

Clinical Examination

  • Palpation of the anterior hip to locate tenderness.
  • Thomas Test: Assessing hip flexibility and iliopsoas tightness.
  • Resisted Hip Flexion Test: Identifying pain on active hip flexion.

Imaging Studies

  • Ultrasound: Can identify tendon thickening, bursal fluid, and inflammation.

Management of Iliopsoas Tendinopathy and Bursitis

Conservative Treatment

  • Rest and Activity Modification: Avoiding repetitive hip flexion movements.

When symptoms persist despite conservative measures, ultrasound-guided injections may be considered.

Ultrasound-Guided Cortisone Injections for Iliopsoas Tendinopathy and Bursitis

What Are Cortisone Injections?

Cortisone is a potent anti-inflammatory steroid that can help reduce inflammation and pain in the affected tendon or bursa.

Why Use Ultrasound Guidance?

  • Ensures precise needle placement into the affected area.
  • Minimises risk of injecting surrounding structures.
  • Improves treatment efficacy by directly targeting inflammation.

Procedure

  1. The clinician applies an ultrasound probe to visualise the iliopsoas tendon and bursa.
  2. The skin is cleaned, and local anaesthetic is administered.
  3. A fine needle is inserted under ultrasound guidance to the target site.
  4. A mixture of cortisone and local anaesthetic is injected into the inflamed bursa or tendon sheath.

Patients are typically advised to limit strenuous activity for a few days post-injection.

Mechanism of Action of Cortisone Injections

Cortisone works by:

  • Reducing inflammation in the bursa or tendon.
  • Suppressing immune response to decrease swelling and pain.
  • Stabilising cellular membranes to prevent further inflammatory damage.

This can lead to improved pain relief and functional recovery in individuals with iliopsoas tendinopathy or bursitis.

Benefits of Cortisone Injections for Iliopsoas-Related Conditions

  • Rapid pain relief compared to oral anti-inflammatory medications.
  • Minimally invasive approach with minimal downtime.
  • Effective for inflammation-related pain in the iliopsoas region.

Conclusion

Iliopsoas tendinopathy and bursitis can cause significant hip pain, limiting mobility and daily activities. When conservative treatments are insufficient, ultrasound-guided cortisone injections can be considered as part of a multidisciplinary approach.

At Alton Pain Clinic, clinicians provide precisely targeted ultrasound-guided injections to help manage pain and improve function in individuals with iliopsoas-related conditions. If you are experiencing persistent hip pain, a comprehensive assessment may help determine the most appropriate treatment strategy.





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