Iliopsoas Bursa Injection

Other Names

• Iliopsoas Bursa Injection

---

Background

Illustration of the Iliopsoas bursa (right)

Key Points

• Needle: 20-22 gauge, 3.5 inch needle
• Transducer: linear or curvilinear depending on body habitus
• Approach: short axis, in plane

Anatomy of Iliopsoas Bursa

• Iliopsoas: Includes psoas major, iliacus and psoas minor and are the major hip flexors
• Lies between the musculotendinous junction of Iliopsoas and the pelvic brim
• Synovial-lined space anterior to the hip joint
• Largest synovial bursa in humans
• Communicates with the hip joint about 15% of of the time

Palpation vs Ultrasound Guided

• We recommend ultrasound guidance, you can not reliably put the needle in the bursa without it

---

Indications

• Hip Flexor Tendonitis

---

Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

---

Procedure

Static transverse (a) and sagittal (b) images show the normal appearance and uniform echogenicity of the iliopsoas tendon (arrows)

Patient and needle positioning. For iliopsoas bursa and peritendon injection, the patient lies supine with hip in neutral position, the transducer is short axis to the iliopsoas tendon, which is approximately parallel to the inguinal ligament, and the needle is directed in plane with the transducer from lateral to medial.

Short Axis, In Plane view. The needle is directed between the deep surface of the iliopsoas tendon and the superficial surface of the ilium (I) from a lateral approach (arrow) at the level of iliopectineal eminence. FA, femoral artery; ILP, iliopsoas muscle; LAT, lateral; MED, medial.

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: typically 21-25 gauge, 1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Transducer: high frequency linear or curvilinear depending on body habitus
• Iliopsoas tendinosis
  • Abnormal hypoechogenicity
  • Tendon tear will appear as anechoic or hypoechoic tendon disruption
  • Iliopsoas bursal distention can range from anechoic (if simple fluid) to isoechoic/hyperechoic
• Snapping Hip Syndrome
  • Short axis, parallel to inguinal ligament
  • Abnormal snapping or abrupt motion of the iliopsoas tendon can be seen dynamically
  • Provocative movements: hip flexion to external rotation or frog leg to straightened position

Technique: Short Axis, In Plane

• Patient Position
  • Supine
  • Hip neutral
• Transducer position
  • Oblique/ short axis to iliopsoas tendon
  • Parallel to inguinal ligament and superior to femoral head
• Needle Approach/ Orientation
  • In plane
  • Lateral to medial
• Target
  • Iliopsoas bursa
  • Inferior to iliopsoas tendon if bursa not evident
• Pearls and Pitfalls
  • Useful to perform a limited scan pre injection
  • Look for other causes of anterior hip pain (paralabral cyst, snapping hip, etc)

---

Aftercare

• No significant restrictions
• Can augment with ice, NSAIDS

---

Complications

• Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
• Painful local reaction
• Infection
• Hyperglycemia
• Tendon, nerve or blood vessel injury

---

See Also

Internal

• Procedures Main
• Ultrasound Main
• Hip Pain Main

---