From the Guidelines
The iliopsoas sign is a significant indicator of iliopsoas muscle irritation or inflammation, which can be evaluated using MRI, as it is highly sensitive and specific for detecting soft tissue abnormalities, including those involving the iliopsoas muscle 1. When evaluating chronic hip pain with suspected extra-articular noninfectious soft tissue abnormality, such as tendonitis, MRI is the preferred imaging technique due to its high sensitivity and specificity for detecting soft tissue abnormalities 1.
Key Points to Consider
- The iliopsoas sign can be indicative of various conditions, including appendicitis, psoas abscess, retroperitoneal hemorrhage, or inflammation of structures adjacent to the psoas muscle.
- MRI is the most appropriate imaging modality for evaluating the iliopsoas muscle and surrounding soft tissues 1.
- Other imaging techniques, such as US and CT, may be used in specific situations, but MRI is generally the first choice for evaluating soft tissue abnormalities 1.
- Diagnostic and therapeutic injections can be useful tools for confirming the location of pain and helping to control it 1.
Evaluation and Diagnosis
To evaluate the iliopsoas sign, a thorough clinical examination, including a review of the patient's medical history and physical examination, should be performed.
- Imaging studies, particularly MRI, should be used to confirm the diagnosis and rule out other potential causes of the patient's symptoms 1.
- The patient's symptoms, such as pain and limited mobility, should be carefully assessed to determine the best course of treatment.
Treatment and Management
Treatment of the iliopsoas sign depends on the underlying cause of the irritation or inflammation.
- In some cases, conservative management, such as physical therapy and pain management, may be sufficient 1.
- In other cases, more invasive procedures, such as surgery, may be necessary to address the underlying condition.
Important Considerations
It is essential to consider the potential risks and benefits of each treatment option and to carefully monitor the patient's progress to ensure the best possible outcome 1.
- A multidisciplinary approach, involving orthopedic surgeons, radiologists, and other healthcare professionals, may be necessary to provide comprehensive care for patients with iliopsoas sign 1.
From the Research
Iliopsoas Sign
The iliopsoas sign is related to the diagnosis of iliopsoas bursitis or tendinitis, which can cause anterior hip pain and snapping hip.
- The diagnosis of iliopsoas bursitis or tendinitis can be challenging due to vague patient complaints and difficulty in discerning it from other hip problems 2.
- Iliopsoas bursitis is characterized by distension of the iliopsoas muscle bursa due to synovial fluid and/or hypertrophic synovium, and can be associated with hip disease or present in isolation 3.
- Imaging techniques such as ultrasound, magnetic resonance, and computerized tomography can be useful in diagnosing iliopsoas bursitis and differentiating it from other conditions 4, 3.
Diagnostic Methods
- History and physical examination are essential in diagnosing iliopsoas bursitis or tendinitis, although real-time ultrasound may be useful in confirming the diagnosis 4.
- Ultrasound-guided corticosteroid injections can be an effective treatment for iliopsoas tendonitis, especially in patients without anterior cup overhang 5.
- Ultrasound examination can also be used to diagnose and treat iliopsoas tendinitis, as illustrated in a case report where ultrasound-guided local injection of long-acting corticosteroid was used to treat the condition 6.
Treatment Options
- Nonoperative management of iliopsoas tendonitis includes anti-inflammatory drugs and image-guided corticosteroid injections 5.
- Surgical management may be necessary in some cases, especially when there is anterior cup overhang, but it does not guarantee treatment success 4, 5.
- Conservative treatment interventions, such as manual therapy and active exercises, can also be effective in managing iliopsoas bursitis or tendinitis 2.