PSOAS SHEATH INJECTION AND PELVIC STABILISATION IN BACK PAIN. LONG TERM OUTCOMES

Abstract

Methods: Anonymous patient questionnaires with reply paid addressed envelopes and separate reply paid consent slip were sent to 134 patients confirmed to have had a psoas sheath injection over six months previously by data base search and then manual confirmation of records. Pain was rated using a 10 point VAS for pain pre procedure and at time of reply. Area of main and secondary pain was recorded. Results: Average length of time in pain was 43 months. At average 14 month follow up: 72% of patients with primary low back pain were good or excellent 69% of patients with primary groin were good or excellent 72% of patients with upper AND lower leg pain were good or excellent The worst responding group were those with lateral hip pain, which is in keeping with labral tears of the hip. 10% of patients were worse on VAS of pain. Those with an excellent response had the following distribution of pain: Main area of pain: LBP 58%, Groin 23%, Upper leg 8% Discussion: Psoas dysfunction is defined as: Low back & or groin pain Tight & tender psoas muscle belly. L23 & L34 facet joint dysfunction. Groin pain in “thomas test” position Positive hip quadrant ± abdominal discomfort The commonest cause is pelvic instability. Others are: Psoas dysfunction and insufficiency syndrome Hip labral tears True back pathology Gross pelvic instability Tumours Conclusion: Psoas sheath injection followed by transversus abdominus retraining appears to have a place in the treatment of back and groin pain. More work needs to be done on identifying those in the good and excellent groups.