Iliopsoas bursitis .

Presented by
MD. Monsur Rahman
MPT-Musculoskeletal disorders (MMIPR,Mullana,Ambala)

1. Iliopsoas Bursitis Presented By MD. MONSUR RAHMAN MPT (Musculoskeletal disorders)

2. Definition: It is the inflammation of the iliopsoas bursa (the largest bursa in the body) that lies between the front of the hip joint and the iliopsoas muscle. It helps reduce rubbing and friction between the bones and soft tissues that meet at the hip joint capsule .

3. Causes of Iliopsoas  bursitis: Hip Pathology Rheumatoid Arthritis Osteoarthritis Infection of the bursa Iliopsoas tendonitis. Tight hip flexor muscles Recreational injuries such as ballet, soccer, martial arts and jumping hurdles. Infection of hip bursa. Repetitive stress (overuse) injury.  Spine disease.  Leg-length inequality Previous surgery.  Bone spurs or calcium deposits. 

4. Symptoms of Iliopsoas  Bursitis: Pain is felt in the anteromedial aspect of the thigh . Pain radiated into the knee, leg and lower back. Tenderness in the upper quads (M. Quadriceps ). A snapping sensation at the front of the hip. Pain develops during walking or specific movements like crossing the legs. Pain on hip flexion, resisted as well as passive. Pain on internal rotation or passive hyperextension. Stiffness or pain after a rest or in the mornings.

5. Cont… Pain is worse while performing activities. Vigorous activities like jogging or kicking a ball with instep Getting up from a seated position Extending the leg while driving Walking up stairs Bringing the knee up to ther chest (especially against resistance) Lying down without support Hip stiffness and tightness in groin as well as the knee, as a result of a tight iliopsoas muscle .

6. Diagnosis: A Physical Exam pain in the anteromedial aspect of the thigh during hip flexion and internal rotation. Edema present in the groin region. A palpable or audible snap can be present. Tenderness in femoral triangle. There is a limitation in range of motion Flexion is lightly painful at the end of ROM. The most painful movement is adduction with the hip in flexion. Radiography: X-ray MRI Hip Musculoskeletal Ultrasound Special test Positive Thomas test

7. Differential Diagnosis - Osteoarthritis - Rheumatoid arthritis - Avascular necrosis - Synovial chondromatosis - Gout - Trauma - Snapping hip - Pyogenic infection

8. Management: Medical management: Rest and ice to the painful region. Modification of activities—avoiding the activities that worsen symptoms. Use of no steroidal anti-inflammatory drugs (NSAIDs). Use of a walking cane or crutches for a week or more when needed. Corticosteroid injections with a local anesthetic.

9. Physical Therapy Application of heat and ice. Electrotherapy like TENS and ultrasound. Soft tissue massage. Stretches. Dry needling. Joint mobilization. Correction of abnormal biomechanics such as using orthotics. Education of the patient. Exercises of the muscles and tendons surrounding the area to improve strength and flexibility. Activity modification and training. Appropriate plan for return to activity.

10. 1. Hip Flexor Stretch Exercise for Iliopsoas Bursitis or Iliopectineal Bursitis: 2. Straight Leg Raises Exercise for Iliopsoas Bursitis or Iliopectineal Bursitis: 3. Sitting Hip Flexion Exercise for Iliopsoas Bursitis or Iliopectineal Bursitis: Exercises for Iliopsoas Bursitis or Iliopectineal Bursitis

11. 4. Standing Resisted Hip Flexion Exercise for Iliopsoas Bursitis or Iliopectineal Bursitis: 5. Gluteal Stretch Exercise for Iliopsoas Bursitis or Iliopectineal Bursitis: