Psoas (hip flexor) Tendonitis

The Psoas tendon is one of the large hip flexors.  It is located in the front of the hip and is made up of contributions of both the iliacus muscle and the psoas muscle.  These originate as high as the mid spine and pelvis and travel down to the hip and femur.  The psoas tendon is particularly susceptible to inflammation and pain.  There is also a bursa between the tendon and the hip joint that is often inflamed when a patient has psoas injuries.  The psoas tendon can be torn, inflamed or have a snapping syndrome where it snaps back and forth over the hip joint.

Diagnosis

The diagnosis of an injured or snapping psoas tendon is primarily made on the patient’s history and physical exam.  Because of the complexity of the hip joint, x-rays and an MRI are often ordered as well to ensure the pain is not coming from other structures.

Non Operative Treatment

Non operative management is the mainstay of treatment.  Stretching and strengthening is the key to treating tendon issues.  Often ice and anti-inflammatories are used to treat acute pain.  Occasionally, a steroid injection is warranted in the psoas tendon or bursa for patients who don’t fully respond.

Surgical Treatment

The need for surgery is rare in isolated psoas tendon issues.  When needed, the psoas tendon is lengthened by releasing it at the mid portion of the musculotendinous junction.  This released position grows back and essentially lengthens the entire tendon.  This additional length allows for smooth movement without recreation of the tendonitis.