Sonographic anatomy and dynamic study of the normal iliopsoas musculotendinous junction

Abstract

The objective of the study was to document the anatomy of the iliopsoas muscle at the level of the groin with the use of sonography. At the same time, behaviour of the muscle during external rotation-flexion and abduction was dynamically evaluated. Forty-two hips in 21 asymptomatic volunteers were studied in static and dynamic conditions. Four bundles of the iliopsoas muscle were identified in all patients. A fifth one was found in only two hips. During dynamic study, a snap was explained by the sudden release of the most medial fibres of the ilacus from an entrapment between the tendon and the superior pubic ramus in 40% of our asymptomatic hips. Anatomy of the iliopsoas muscle can be accurately depicted by sonography at the level of the groin. Snapping of the muscle is often encountered as a physiological finding.

A review of imaging modalities for the hip

“…In patients with symptomatic snapping iliopsoas tendon, the medial fibers of the iliacus become temporarily interposed between the psoas major tendon and the ilium, and during the return to a straight-leg position, the muscle tendon unit can be visualized abruptly snapping back into place, with the iliopsoas tendon making contact with the ilium. The ultrasound evidence may be correlated with a palpable snap felt in the transducer hand of the examiner and exacerbated symptoms felt by the patient [3,22]. Additional locales for snapping hip syndrome include a snapping iliotibial band or gluteus maximus relative to the greater trochanter and intraarticular loose bodies, the former of which may be identified more readily via ultrasound [3,23].…”

“…This becomes increasingly useful in the athletic patient with dynamic snapping or catching with specific provocative maneuvers of athletic activity. Dynamic ultrasound and ultrasound-guided injections are often implemented to make the diagnosis of coxa saltans interna or externa [3,22]. With the transducer centered over the iliopsoas at the level of the inguinal ligament, the patient is prompted to flex and externally rotate the hip into a frogleg position and then slowly return the leg to a straight position.…”

Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip

“…Also, two hips showed complete splitting or a bifid psoas major tendon, which appeared physiologic [20]. Additionally, a recent dynamic sonographic study of 42 hips of healthy volunteers aiming to observe the five components, as described by Tatu et al [20], also reported one hip with a double or bifid psoas major portion of the iliopsoas tendon [7]. Based on these limited reports, a bifid iliopsoas tendon probably arises from a divide in the psoas major part of the iliopsoas tendon and most likely arises as a constitutional anatomic variant.…”

Les ressauts de hanche expliqués par l’échographie

“…Guillin et al ont bien décrit l'anatomie échographique statique et dynamique du tendon du psoas [7].…”