Psoas Impingement

Psoas Impingement, also known as Internal Snapping Hip Syndrome, occurs when the iliopsoas tendon, located on the front of the hip joint, becomes inflamed and tight due to repeated abnormal motion of the hip. This motion causes the ITB band to snap across the pelvis and socket (acetabulum). The tendon can also compress the labrum, the cartilage that surrounds the socket (acetabulum), causing it to be crushed or torn. This condition is commonly seen in athletes who over-use the iliopsoas tendon such as gymnasts, dancers, and track and field participants, where the hip flexion muscle is used repeatedly.

Symptoms

The principal symptoms of psoas impingement are hip pain, inflammation and soreness. The patient experiences tightness in the hip or pain during activities that require flexibility and/or extension. A snapping feeling may be felt in the front part of the hip.

Diagnostic Testing

Dr. Padalecki will conduct a thorough physical exam to evaluate the hip and rule out other pathologies. He will utilize x-rays to review the hip bone specifically as well as an MRI (magnetic resonance imaging) to examine the soft tissues and cartilage within the hip. In some cases he may order a dynamic ultrasound to confirm the diagnosis.

Treatment

Non-Surgical

Psoas impingement injuries can be treated without surgery through rest, anti-inflammatory medication, and a regimented stretching program. Slow and gradual strengthening of the muscle will help protect the hip from re-injury. In some cases, the use of a steroid injection into the hip may help decrease the inflammation of the tendon, reduce pain, and allow for ease in returning to normal activity. When a psoas tendon is symptomatic, injections can be performed under ultrasound. In many cases a painful psoas tendon often results in compression and tearing of the labrum. When this is the case, an injection may not provide maximum relief. Dr. Padalecki will consult in this situation and discuss surgery alternatives.

Surgical

If surgery is required, Dr. Padalecki examines the hip through the use of an arthroscope. He is able to determine if the psoas tendon is tight with the arthroscopic examination on the operating table. For tight tendons, Dr. Padalecki performs a fractional lengthening of the tendons to make it longer, thereby relieving the symptoms associated with the tightness and preserving hip flexion strength. Any other hip pathology that is discovered through the diagnostic tests can be treated through the same incisions.

Post-Op

A rehabilitation and physical therapy program will be prescribed at your first post-operative visit with Dr. Padalecki. Initially, the therapy will focus on slowly returning motion back to the injured hip. After that is achieved, you will follow a progressive strengthening program to protect the repaired hip and avoid future damage or degenerative issues.

For additional resources on psoas impingement of the hip, or for more information other types of hip injuries, please contact the office of Dr. Jeff Padalecki, orthopedic surgeon in Austin, Texas.