From the Guidelines
Diagnosing iliopsoas snapping syndrome requires a combination of clinical evaluation and imaging studies, with a thorough history and physical examination being the first steps, as recommended by the International Hip-related Pain Research Network 1. The diagnostic criteria for iliopsoas snapping syndrome involve a combination of clinical and imaging findings.
- A thorough history focusing on activities that provoke the snapping sensation, typically flexion, adduction, and external rotation of the hip, is essential.
- Physical examination should include palpation of the iliopsoas tendon during active hip movements to reproduce the snapping.
- The most reliable clinical test is the supine iliopsoas test, where the examiner moves the patient's hip from a flexed, abducted, and externally rotated position to extension, adduction, and internal rotation while palpating for the snap. Imaging studies, such as dynamic ultrasound, can visualize the tendon movement in real-time and confirm the diagnosis by showing the iliopsoas tendon snapping over the femoral head or iliopectineal eminence, as supported by the American College of Radiology 1.
- MRI may be useful to rule out other pathologies but cannot capture the dynamic snapping.
- X-rays are typically normal but help exclude bony abnormalities.
- Diagnostic injection of local anesthetic into the iliopsoas bursa that relieves symptoms can further confirm the diagnosis, as suggested by the British Journal of Sports Medicine 1. This systematic approach is necessary because the condition is often confused with other causes of hip pain or snapping, such as intra-articular pathology or external snapping from the iliotibial band. The International Hip-related Pain Research Network recommends that imaging should never be used in isolation but combined with the patient’s symptoms and clinical signs when making treatment and other relevant decisions 1. By following these diagnostic criteria, clinicians can accurately diagnose iliopsoas snapping syndrome and develop an effective treatment plan to improve patient outcomes, reducing morbidity, mortality, and enhancing quality of life.
From the Research
Diagnostic Criteria for Iliopsoas Snapping Syndrome
The diagnostic criteria for iliopsoas snapping syndrome include:
- A history of painful snapping or clicking in the hip area 2, 3, 4, 5, 6
- Physical examination maneuvers that reproduce the snapping or clicking sound 2, 4
- Imaging studies such as ultrasound or MRI to confirm the diagnosis and rule out other pathologies 2, 3, 4, 5, 6
- Dynamic ultrasonography to detect transient subluxation of the iliopsoas tendon 4
- Ultrasound-guided anesthetic injection of the psoas bursa to confirm snapping of the iliopsoas tendon as the cause of hip pain 3
Clinical Findings
Clinical findings of iliopsoas snapping syndrome may include:
- Thickening of the iliopsoas tendon (tendinitis) 4
- Peritendinous fluid collection 4
- Iliopsoas bursitis 4, 6
- Transient subluxation of the iliopsoas tendon 4
- Hip flexor weakness after surgery 3, 5
Imaging Findings
Imaging findings of iliopsoas snapping syndrome may include: