What is psoas tendinopathy?
Psoas tendinopathy (or tendinitis) is inflammation and/or partial tearing of the psoas tendon, which is located deep in the hip joint, attached to the lesser trochanter (a small bony prominence next to the hip). The psoas is a very important hip flexor. When this tendon becomes inflamed or irritated, it causes pain in the hip, which is usually felt in the groin or inner thigh. The psoas can also become inflamed following a total hip replacement.
What are the symptoms of psoas tendinopathy?
Psoas tendinopathy typically causes the following symptoms:
- Pain on the inside of the hip, groin and thigh
- Pain with lifting up the leg
- Pain that gets worse during activities such as getting up from a deep chair or getting out of a car
- Pain with walking up stairs
How is psoas tendinopathy diagnosed?
A well-trained doctor or other paramedical professional will suspect psoas tendinopathy based on your symptoms and a thorough examination of your hip. Resisted hip flexion and straight leg raise will often reproduce the pain. The diagnosis will often be confirmed by additional tests such as ultrasounds and MRIs. Not all of these tests are required to confirm the diagnosis.
MRIs are helpful in visualising the soft tissues around the hip. It can demonstrate an inflamed psoas bursa and inflammation or partial tearing of the psoas tendon. It is also useful for visualising associated gluteal tendon tears or tendinopathy adjacent to the bursa.
What are the causes of psoas tendinopathy?
Psoas tendinopathy may result from one or more of the following events:
- Play or work activities that cause overuse or injury to the joint area. Such activities might include running up stairs or climbing.
- Stress on the soft tissues. This may be a result of an abnormal or poorly positioned joint or bone (such as leg length discrepancies or arthritis in a joint).
- Other diseases or conditions. These may include rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction. In rare cases, bursitis may result from infection.
- Previous surgery around the hip or prosthetic implants (THR) in the hip.
- Hip bone spurs or calcium deposits in the tendons that attach to the trochanter.
The cup (acetabular component) of a total hip replacement can cause irritation to the psoas tendon as the tendon rubs against it.
Is psoas tendinopathy dangerous?
Psoas tendinopathy is not life-threatening, but it can severely impact your quality of life and function. Most cases of tendinitis improve without any treatment over a few weeks. See your health care provider if you have any of the following signs or symptoms:
- You experience pain that interferes with your normal day-to-day activities or have soreness that does not improve despite self-care measures.
- You have recurrence or repeated bouts of tendinitis.
What is the treatment for psoas tendinopathy?
Treatment goals include reducing pain and inflammation, preserving mobility, and preventing disability and recurrence.
Treatment recommendations may include a combination of rest, physiotherapy, massages, heat, and cold application. More advanced treatment options include:
- Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen
- Corticosteroid injections or PRP (i.e., protein rich plasma) injections given by your health care provider. Injections work quickly to decrease the inflammation and pain.
- Physical therapy that includes range of motion exercises, stretches and hydrotherapy. This can be very beneficial.
Surgery is only recommended when other treatments are not effective. Recalcitrant psoas tendinopathy can be treated with arthroscopic (i.e., keyhole surgery) psoas tenotomy. Psoas tenotomy effectively lengthens the tendon, allowing the tendon to heal in a lengthened position within the tendon sheath, thus stopping the tendon irritation.
When can I walk after psoas tenotomy?
Full weight-bearing and walking is allowed immediately. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days postoperatively.
When can I drive after psoas tenotomy?
You should not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. If you had a left hip procedure and drive an automatic, you can drive whenever you feel comfortable. Otherwise, it is reasonable to drive when you are confident with walking and can fully weight-bear on your affected side.
When can I return to work after psoas tenotomy?
Your return to work will vary depending on the type of work you are engaged in. Most people can return to office work within 2-4 weeks. Labour intensive work however, may require you to take 4-6 weeks before returning to full duties.
When can I play after psoas tenotomy?
Low impact activities, such as cycling and swimming, can be commenced from week 6. High impact activities such as running are best avoided for 10-12 weeks after surgery.
How long will it take to heal after psoas tenotomy?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from a hip arthroscopy procedure.
How much pain will I experience after psoas tenotomy?
Local anaesthetic is injected around the wound during the procedure and most patients are pleasantly surprised at how little pain they have after the procedure.
What are the risks of psoas tenotomy?
Complications are not common but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision regarding the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your your surgeon.
Some patients occasionally report numbness or tingling in the groin or inner thigh. This usually resolves with time. It is quite normal to experience some swelling and discomfort in the leg, thigh and buttock region. This is expected and will also resolve with time.
Other general surgical risks include: risk of infection, bleeding and clots in the leg (DVT) or lung postoperatively.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well being and health.
- Femoroacetabular Impingement
- Cam Impingement
- Pincer Impingement
- Labral Tears
- Ligamentum Teres Tear
- Trochanteric Bursitis
- Psoas Tendinopathy
- Muscle Strain
- Hip Bursitis
- Hip Avascular Necrosis
- Hip Fracture
- Hip Dislocation
- Gluteus Medius Tear
- Hip Labral Tear
- Chondral Lesions
- Hip Instability
- Loose Bodies
- Hip Osteoarthritis
- Inflammatory Arthritis of the Hip
- Childhood Hip Problems