Iliopsoas bursitis is a common cause of anterior hip pain. The iliopsoas bursa is one of the largest bursa in the body and lies within the medial femoral triangle between the insertional tendon of the iliopsoas muscle and the hip joint (Fig. 122.1). The bursa serves to cushion and facilitate sliding of the musculotendinous unit of the iliopsoas muscle over the bony hip joint (Fig. 122.2). The bursa is subject to inflammation from a variety of causes with acute trauma to the hip and repetitive microtrauma being the most common. Acute injuries to the bursa can occur from direct trauma from seat belt during motor vehicle accidents as well as from overuse injuries that required repeated hip flexion, such as javelin throwing and ballet. Direct pressure that forces the iliopsoas bursa against the hip joint when sitting while leaning forward for prolonged periods has also been implicated in the development of iliopsoas bursitis. If the inflammation of the bursa is not treated and the condition becomes chronic, calcification of the bursa with further functional disability may occur. Gout and other crystal arthropathies may also precipitate acute iliopsoas bursitis as may bacterial, tubercular, or fungal infections.

The patient suffering from iliopsoas bursitis most frequently presents with the complaint of severe pain with any pressure on the area overlying the anterior hip joint and inflamed iliopsoas bursa. Extension and rotation of the hip will exacerbate the pain, and the patient may alter their gait by taking shorter “baby steps” with the affected extremity to avoid extending the leg. Physical examination of the patient suffering from iliopsoas bursitis will reveal point tenderness over the medial anterior hip. The pain may radiate into the anterior thigh. If there is significant inflammation, rubor and color may be present and the entire area may feel boggy or edematous to palpation. Swelling, which at times can be quite dramatic, is often present and may actually compress adjacent nerves causing numbness, which can confuse the clinical picture (Fig. 122.3). Often, the swelling of iliopsoas bursitis is misdiagnosed as an inguinal hernia. If calcification or gouty tophi of the bursa and surrounding tendons are present, the examiner may appreciate crepitus with active extension and

rotation of the hip, especially in the sitting position. Often, the patient will not be able to sleep on the affected side.

Plain radiographs are indicated in all patients who present with hip pain to rule out occult bony pathology. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging (MRI) or ultrasound imaging of the affected area may also confirm the diagnosis and help delineate the presence of other hip bursitis, calcific tendonitis, tendinopathy, triceps tendonitis, or other hip pathology (Fig. 122.4). MRI or ultrasound imaging of the affected area may also help delineate the presence of calcific tendonitis or other hip pathology. Rarely, the inflamed bursa may become infected and failure to diagnose and treat the acute infection can lead to dire consequences.