Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip

Abstract

Background Treatment of painful internal snapping hip (coxa saltans) via arthroscopic lengthening or release of the iliopsoas tendon is becoming preferred over open tech-

Internal Snapping Hip Syndrome: Incidence of Multiple-Tendon Existence and Outcome After Endoscopic Transcapsular Release

“…[2][3][4][5][6][7][8][9] Anderson and Keene 2 studied a series of 15 athletes treated for ISHS with endoscopic release at the level of the lesser trochanter. None of the patients had recurrent snapping or pain in the hip at 3, 6, or 12 months.…”

“…Revision surgery was successful by releasing the remaining tendon. 6 Deslandes et al 4 reported on 18 patients with painful internal snapping hips. Two patients were found to have bifid tendons; in 1 patient the phenomenon was bilateral, which was discovered by retrospective review of dynamic ultrasound recordings of the snapping phenomenon.…”

“…4,5 Recently, the presence of a bifid psoas tendon has been recognized as a cause of recurrence of ISHS after surgical treatment. 6 Our purpose was to report the frequency of presentation of bifid or multiple iliopsoas tendons in patients who underwent endoscopic release of the iliopsoas tendon for ISHS and compare the results of both presentations after transcapsular endoscopic release. The hypothesis was that central-compartment release of multiple tendons for ISHS would provide adequate results, comparable with those of singletendon snapping, if the multiple tendons were identified and completely released.…”

The Hip in Ice Hockey: A Current Concepts Review

“…Traditionally, the iliopsoas tendon is described as a conjoined tendon of the psoas major (originating from the transverse process of the lumbar vertebrae) and iliacus muscles (originating from the upper two-thirds of the iliac fossa and inner lip of the iliac crest) with insertion on the lesser trochanter. 21,22 This particular muscle group is often implicated in hip flexion, 23 including movements such as kicking and running, and thus the prevalence of iliopsoas injury is observed to be highest among soccer players and running athletes. 16 However, it can also be a cause of groin pain in the ice hockey player because the iliopsoas is also implicated in lumbar posture and pelvic control.…”

The anatomy and relevance of the iliopsoas in the young adult with hip pain: Role of arthroscopic intervention

“…However the tendon could be bifid as reported by Shu et al in 2011, during revision arthroscopy. 13 The psoas tendon lies lateral to the femoral artery, while the iliopsoas bursa lies between the musculotendinous junction and the pelvic brim. 11 Hence the psoas tendon is easily palpable lateral to the femoral artery pulsations.…”