Psoas Impingement Overview
The hip joint is a ball and socket type joint made of the femoral head (ball) and a part of the pelvis called the acetabulum (socket). In certain patients the ball and/or socket are not properly shaped which leads to a condition called femoroacetabular impingement (FAI). In these cases, or in patients whose activities require repetitive flexion of the hip, a muscle known as the Iliopsoas (psoas) can become very tight. The psoas tendon (extension of the muscle that inserts onto the bone) crosses over the top of the hip joint and can therefore be irritated in cases of impingement. When the muscle tightens and causes symptoms such as pain or snapping this is referred to as psoas tightness or psoas impingement. This condition can occur separately from FAI but is almost always involved with the overuse of the psoas muscle in the hip, most commonly among athletes. While stretching has been shown to be effective in preventing the tightness, if the condition of psoas impingement does develop it may cause snapping hip syndrome, irritation, and pain. Hip specialist Dr. Boykin is an expert at treating psoas impingement in patients in Asheville, Arden, Fletcher and surrounding communities.
What are Symptoms of Psoas Impingement?
Symptoms most commonly associated with psoas impingement include:
- Deep soreness in the front of the hip/groin
- Tightness in the front of the hip
- Pain with activities requiring hip flexion
- A snapping or popping sensation in the front of the hip
Diagnosis of Psoas Impingement
In order to properly diagnose psoas impingement Dr. Boykin will take a detailed history and thoroughly evaluate the hip on physical examination. Specific exam tests for psoas impingement include producing a popping sound with motion of the hip and the Thomas test to check for psoas tightness. X-rays will be taken to assess for FAI and other hip conditions. In cases where there is a high suspicion of psoas involvement, a MRI may be ordered to give a better view of the tendon and ensure that there is no further damage within the hip joint.
How to Treat Psoaas Impingement
In most cases impingement can be treated non-surgically through a combination of rest, anti-inflammatory medications and aggressive stretching with proper rehabilitation. Another treatment technique that may be helpful is an injection into the hip and/or psoas tendon to decrease inflammation, reduce pain, and allow a patient to exercise and strengthen the joint. An injection also gives useful information for determining the exact cause of the symptoms. In the event that the injury does not respond to non-surgical methods, Dr. Boykin will discuss surgical options with the patient.
Psoas Impingement Surgical Treatment
When psoas impingement requires surgery, Dr. Boykin will use an arthroscopic surgical technique with small incisions, a camera, and special instruments. After fully assessing and treating any other damage within the hip (including FAI) he will check the psoas tendon. If the tendon is tight and causing symptoms he will perform a technique called a “fractional lengthening”. This refers to a procedure to make the tendon longer and reduce the tension and tightness. This has been shown to be effective in relieving symptoms and maintaining strength of the hip flexor.
For more information on psoas impingement as well as any other hip, knee, or shoulder injury, please contact Dr. Robert Boykin, orthopedic surgeon treating patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.