Iliopsoas Bursitis

What is it?

Bursa deep to iliopsoas tendon inflames from overuse or hip pathology; may communicate with the hip joint given its deep location.

Commonly affected: Bursa deep to iliopsoas tendon (over iliopectineal eminence)

How it develops

1. Repetitive Hip FlexionFriction from running, kicking, squatting
2. Bursal InflammationSynovial inflammation with effusion
3. Joint CommunicationBursa may communicate with hip joint
4. Snapping HipTendon snaps over bony prominence

Symptoms

• Anterior groin painDeep anterior hip pain
• Pain on resisted flexionPain with resisted hip flexion
• Worse stairs/entering carPain with hip flexion activities
• Snapping/clickingWith hip flexion/extension
• Focal swelling (rare)Palpable mass if large bursa

How it is examined

• Groin tendernessDeep tenderness over iliopectineal eminence
• Thomas testAssess iliopsoas tightness
• Resisted hip flexionPain with resisted flexion
• Internal snappingClick on extension from FABER position

Imaging

Usually normal; evaluate coexisting hip OA or osseous cause.

• Usually normal
• Possible associated hip OA
• Rare calcification
• Assess FAI features

MRI/US useful — fluid deep to iliopsoas, possible hip joint communication.

• Fluid deep to iliopsoas (T2↑)
• Bursal thickening
• Possible hip joint communication
• Associated FAI or labral tear

When surgery is considered

Conservative failure with persistent painful snapping

Procedures that may be discussed

• Iliopsoas tendon release (endoscopic or open)
• Bursectomy

Outlook

Most improve in 6–12 weeks; address associated hip pathology for best outcome.