Iliopsoas injury: an MRI study of patterns and prevalence correlated with clinical findings
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SCIENTIFIC ARTICLE
Iliopsoas injury: an MRI study of patterns and prevalence correlated with clinical findings Kimmie L. Bui & Hakan Ilaslan & Michael Recht & Murali Sundaram
Received: 14 August 2007 / Revised: 29 September 2007 / Accepted: 9 October 2007 / Published online: 20 November 2007 # ISS 2007
Abstract Objectives The objective was to retrospectively determine the prevalence and patterns of iliopsoas injuries based on consecutive MRI examinations, correlated with clinical findings. Materials and methods From 4,862 consecutive MRI examinations of the hips and pelvis, 32 patients with 33 iliopsoas injuries were identified and graded as muscle strain, partial tendon tear, and complete tendon tears. These patients’ medical records were reviewed to determine age, gender, and cause of symptoms. Results The prevalence of iliopsoas tendon and myotendinous injuries was 0.66% (95% CI: 0.44–0.89). There were 18 females and 14 males whose ages ranged from 7 to 95 years (mean, 54 years). The most frequent presenting symptom was hip pain and the most frequent clinical diagnosis, an occult fracture. The most common injuries in patients under 65 years (16 patients) were muscle strains and partial tendon tears, most often due to an athletic injury. The most common injury in patients 65 years and older (16 patients) was a complete tear (8 patients, all females), 2 of which were spontaneous in origin. Conclusions Each grade of iliopsoas injury occurred with similar frequency. The more advanced the age of the patient, the more severe the injury. Non-athletic injuries
Since acceptance of this manuscript we have had two further complete iliopsoas tendon tears with retracted tendons. Both were females (79 years and 65 years respectively) who had MRI’s following falls to exclude fracture. One patient (79 years) was healthy with no known systemic disease. The other had been previously diagnosed with polymyalgia rheumatica and received methotrexate and steroids. K. L. Bui (*) : H. Ilaslan : M. Recht : M. Sundaram Department of Radiology, Cleveland Clinic, C/o Sylvia Zavatchen, HB6, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail: [email protected]
predominated in patients 65 years and older; athletic injuries were the most common cause of iliopsoas injury in patients under 65 years. Keywords Hip pain . Iliopsoas tear . Iliopsoas tendinopathy . MRI
Introduction Iliopsoas injuries in general are considered uncommon and their prevalence is unknown. Iliopsoas tendinosis is often associated with kicking related sports, although the prevalence is unknown in this or other athletic pursuits [1]. A familiar iliopsoas injury is avulsion of the iliopsoas tendon (IPT) with detachment of the lesser trochanter, secondary to an athletic injury in the growing skeleton prior to fusion of the lesser trochanter apophysis [2]. An avulsion of the lesser trochanter in an adult, in the absence of trauma, is regarded as a sign of metastatic disease until proven otherwise [3]. Complete IPT tears without lesser trochanteric avulsion are distinctly uncommo
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