Arthroscopic treatment of the painful "internal" snapping hip: results of a new endoscopic technique and imaging protocol.
BACKGROUND
Traditional surgical treatment for a painful snapping iliopsoas tendon has been an open lengthening of the tendon.


OBJECTIVE
An endoscopic release will alleviate painful snapping of the tendon.


METHODS
Case series; Level of evidence, 4.


METHODS
Six patients with painful snapping hips who had no pain relief after magnetic resonance arthrography, which included injection of bupivacaine into the hip joint, subsequently had an ultrasound evaluation of their iliopsoas tendons and an anesthetic injection into the psoas bursa. In all 6 patients, the injection relieved their hip pain, and in 4, real-time imaging demonstrated snapping of the tendon. All hips were evaluated with the 100-point Harris hip scoring system before and at 1.5, 3, 6, and 12 months after surgery.


RESULTS
Preoperative hip scores averaged 58 points. After surgery, all patients had hip flexor weakness, used crutches for 5 weeks, and had 6-week scores that averaged 62 points. The patients continued to improve, and at 6 and 12 months, their scores averaged 90 and 96 points, respectively, and none had recurrence of their snapping or pain.


CONCLUSIONS
Ultrasound-guided anesthetic injection of the psoas bursa is useful to confirm snapping of the iliopsoas tendon as the cause of a patient's hip pain. Endoscopic release of the tendon is a safe outpatient procedure that provides effective relief of the snapping and pain.
Flanum
Mark E
ME
Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Keene
James S
JS
Blankenbaker
Donna G
DG
Desmet
Arthur A
AA
D000328:Adult; D001182:Arthroscopy; D005260:Female; D025981:Hip Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D016658:Psoas Muscles; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography