Internal Snapping Hip Syndrome Research Articles

The role ofiliopsoas fractional lengthening inhip arthroscopy: a systematic review.

Arthroscopic iliopsoas fractional lengthening (IFL) is a surgical option for the treatment of internal snapping hip syndrome (ISHS) after failing conservative management. Systematic review. A search of PubMed central, National Library of Medicine (MEDLINE) and Scopus databases were performed by two individuals from the date of inception to April 2023. Inclusion criteria were ISHS treated with arthroscopy. Sample size, patient-reported outcomes and complications were recorded for 24 selected papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and registered on PROSPERO database for systematic reviews (CRD42023427466). Thirteen retrospective case series, ten retrospective comparative studies, and one randomized control trial from 2005 to 2022 were reported on 1021 patients who received an iliopsoas fractional lengthening. The extracted data included patient satisfaction, visual analogue scale, the modified Harris hip score and additional outcome measures. All 24 papers reported statistically significant improvements in post-operative patient-reported outcome measures after primary hip arthroscopy and iliopsoas fractional lengthening. However, none of the comparative studies found a statistical benefit in performing IFL. Existing studies lack conclusive evidence on the benefits of Iliopsoas Fractional Lengthening (IFL), especially for competitive athletes, individuals with Femoroacetabular Impingement (FAI), and borderline hip dysplasia. Some research suggests IFL may be a safe addition to hip arthroscopy for Internal Snapping Hip Syndrome, but more comprehensive investigations are needed. Future studies should distinguish between concurrent procedures and develop methods to determine if the psoas muscle is the source of pain, instead of solely attributing it to the joint.

Multiple iliopsoas tendons: a cadaveric study and treatment implications for internal snapping hip syndrome

PurposeThis cadaveric study aimed at describing the anatomical variations of the iliopsoas complex.MethodsThe iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers—13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas.ResultsThe presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P < 0.001).ConclusionsThe results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described.Level of evidenceLevel V

Arthroscopic treatment of internal snapping hip

Introduction:Internal snapping hip syndrome (ISHS) is caused by the iliopsoas tendon snapping over either the iliopectineal ridge or the anterior femoral head. Excellent results are achieved only with activity modification, rest, and stretching the iliopsoas muscle. The literature favors iliopsoas tendon release if conservative therapy fails. There is little evidence about the gold standard of this condition.Objective:Describe clinical results, complicactions and recurrence rate of arthroscopic treatment of ISHS.Methods:We included all patients who failed conservative treatment and were treated with arthroscopy for ISHS between March 2012 and March 2018. Patients with less than 2 years of follow up and previous surgery on the hip were excluded.We performed Ilizariturri´s technique with a transcapsular endoscopic release in central compartment.We registered modified Harris hip score (MHHS), Hip outcome score activity of daily living (EHOSDL), patients satisfaction, recurrence rate and complications.Results:Eight patients were included. Average follow up was 36 months (range 24-60 months). MMHS improved from preoperative average score of 70 (range 62-72) to postoperative average of 93 (range 92 to 96). Average EHOSDL improvement was 30% (from 55% preoperative to 85% postoperative). All patients had excellent results. Average patient satisfaction was 8 (range 7-9). We had no recurrence or complications.Conclusion:Arthroscopic treatment of ISHS allowed us to obtain very good clinical results with no complications or recurrences with a minimum 2 years follow up.

Internal snapping hip syndrome in dynamic ultrasonography.

Snapping hip syndrome is an audible or palpable snap in a hip joint during movement which may be accompanied by pain or locking. It is typically seen in young athletes performing activities requiring repeated extreme movements of the hip. It may also follow a physical trauma, intramuscular injections or surgeries. There are two main forms of snapping hip: extra- or intra-articular. Extra-articular snapping hip is elicited by an abnormal movement of specific tendons and is divided into two forms: internal and external. The internal form of snapping hip syndrome is attributed to an abrupt movement of an iliopsoas tendon against an iliopectineal eminence. Radiograph results in patients with this form of snapping tend to be normal. Dynamic ultrasound is the gold standard diagnostic technique in both forms of extra-articular snapping hip syndrome. The objective of the following text is to describe a step-by-step dynamic ultrasonography examination in internal extra-articular snapping hip syndrome in accordance to the proposed checklist protocol. To evaluate abrupt movement of an involved tendon, the patient needs to perform specific provocation tests during the examination. With its real-time imaging capabilities, dynamic ultrasonography detects the exact mechanism of the abnormal tendon friction during hip movement in a noninvasive way. It also allows for a diagnosis of additional hip tissue changes which may be causing the pain.

Endoscopic release of internal snapping hip: a review of literature.

Internal snapping hip is a common clinical condition, characterized by an audible or palpable snap of the medial compartment of the hip. In most cases it is asymptomatic, while in a few patients, mostly in athletes who participate in activities requiring extremes of hip range of motion, the snap may become painful (internal snapping hip syndrome - ISHS). This is a review of current literature, focused on the pathogenesis, diagnosis and treatment of ISHS. The pathogenesis of ISHS is multifactorial, and it is traditionally believed to be caused by the tendon snapping over the anterior femoral head or the iliopectineal ridge. Most cases of ISHS resolve with conservative treatment, which includes avoidance of aggravating activities, stretching, and NSAIDs. In recalcitrant cases, surgery may be indicated. Better results have been reported with endoscopic iliopsoas tendon release compared with open techniques, which may be related to the treatment of concomitant intra-articular pathologies. Furthermore, endoscopic treatment showed fewer complications, decreased failure rate and postop erative pain. It is important to remember that in most cases, a multiple iliopsoas tendon may exist, and that the incomplete release of the iliopsoas tendon can be a reason for refractory pain and poor results. Then, even if of not clinical relevance at long term follow-up, patients should be told about the inevitable loss of flexion strength after iliopsoas tenotomy. II.

Internal Snapping Hip Syndrome: Incidence of Multiple-Tendon Existence and Outcome After Endoscopic Transcapsular Release

To report the frequency of presentation of bifid or multiple iliopsoas tendons in patients who underwent endoscopic release for internal snapping hip syndrome (ISHS) and to compare both groups. A consecutive series of patients with ISHS were treated with endoscopic transcapsular release of the iliopsoas tendon at the central compartment and prospectively followed up. The inclusion criteria were patients with a diagnosis of ISHS with failure of conservative treatment. During the procedure, the presence of a bifid tendon was intentionally looked for. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at last follow-up. Four patients presented with a bifid tendon and one patient had 3 tendons. At a minimum of 12 months' follow-up, the presence of snapping recurrence was evaluated and the WOMAC scores were compared between both groups. Among 279 hip arthroscopies, 28 patients underwent central transcapsular iliopsoas tendon release. The mean age was 29.25 years (range, 16 to 65 years; 6 left and 22 right hips). Group 1 included 5 patients with multiple tendons; the remaining patients formed group 2 (n = 23). None of the patients presented with ISHS recurrence. The mean WOMAC score in group 1 was 39 points (95% confidence interval [CI], 26.2 to 55.4 points) preoperatively and 73.6 points (95% CI, 68.4 to 79.6 points) at last follow-up. In group 2 the mean WOMAC score was 47.21 points (95% CI, 44.4 to 58.2 points) preoperatively and 77.91 points (95% CI, 67.8 to 83.4 points) at last follow-up. We identified a bifid tendon retrospectively on magnetic resonance arthrograms in 3 of the 5 cases that were found to have multiple tendons during surgery. None of these were recognized before the procedures. In this series the surgeon intentionally looked for multiple tendons, which were found in 17.85% of the cases. Clinical results in patients with single- and multiple-tendon snapping seem to be similarly adequate. However, the possibility of a type II error should be considered given the small number of patients. Level IV.

Central Compartment Release Versus Lesser Trochanter Release of the Iliopsoas Tendon for the Treatment of Internal Snapping Hip: A Comparative Study

To evaluate the results of 2 different techniques of endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Between January 2008 and January 2012, a consecutive series of patients with the diagnosis of internal snapping hip syndrome were treated with endoscopic release of the iliopsoas tendon. The patients were divided into 2 groups according to the surgical technique used. Group 1 was treated with endoscopic iliopsoas tendon release at the lesser trochanter, and group 2 was treated with iliopsoas release from the central compartment. Hip arthroscopy of both the central and peripheral compartments was performed in both groups by the lateral approach. Associated injuries were identified and treated arthroscopically. The postoperative physical therapy protocol was the same for both groups. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at last follow-up at a minimum of 24 months. Twenty patients were included in the study: 6 in group 1 (4 male and 2 female patients; mean age, 35.6 years) and 14 in group 2 (5 male and 9 female patients; mean age, 32.7 years). Associated injuries were found and treated in 4 patients in group 1 and 10 patients in group 2. Every patient in both groups had an improvement in the WOMAC score. One patient in group 2 presented with recurrence of snapping that required surgical intervention. No complications were seen. Both central compartment release and release at the lesser trochanter produced favorable results, based on WOMAC scores, for the treatment of internal snapping hip syndrome. Level IV, therapeutic case series.

Efficacy of Surgery for Internal Snapping Hip

Our purpose was to evaluate evidence regarding the effectiveness of open iliopsoas release and lengthening with arthroscopic approaches, which combine iliopsoas release with the treatment of intra-articular pathology as treatments for internal snapping hip syndrome. Searches were performed of 4 databases and 12 reports on the surgical treatment of internal snapping hip were reviewed. The authors tabulated data according to year of study, journal, study type, level of evidence, patient demographics, procedure, and outcomes. We found that surgical treatment of internal snapping hip improves patient symptoms in the majority of patients. Endoscopic release is associated with fewer reported complications compared with open release. All studies of endoscopic treatment of internal snapping hip syndrome also performed intra-articular examination and treatment of intra-articular pathology. The incidence of associated intra-articular pathology was reported in 5 of 6 studies. These results suggest that a painful snapping iliopsoas tendon in many cases may be a result of intra-articular hip pathology rather than an independent entity. Early studies suggest no difference in efficacy or associated complications rate when comparing extracapsular to transcapsular iliopsoas tendon release. Further studies are needed comparing operative to nonoperative treatment and methods of determining patients likely to benefit from operative intervention.

Surgical Management of Internal Snapping Hip Syndrome: A Systematic Review Evaluating Open and Arthroscopic Approaches

This systematic review explored reported outcomes addressing internal snapping hip as well as comparing outcomes between open and arthroscopic management of internal snapping hip syndrome. Two databases (Embase and Medline) were screened for clinical studies involving the surgical management of internal snapping hip syndrome. Two reviewers conducted a full-text review of eligible studies and the references of these studies. Inclusion and exclusion criteria were applied to the searched studies, and a quality assessment was completed for included studies. We identified 11 eligible studies involving 248 patients. The mean age of the participants was 26.5 years (range, 14 to 62 years). The 2 most commonly reported standardized outcome measures were the modified Harris Hip Score (27%) and the Western Ontario and McMaster Universities Osteoarthritis Index (18%). Six studies (54%) presented return to the same level of competition or activities of daily living as an outcome. Among patients undergoing arthroscopic management for this condition, postoperative improvements in the modified Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score were greater in the studies involving transection at the lesser trochanter compared with the transcapsular technique. Standardized outcome measures were not reported among patients undergoing open procedures. Resolution of snapping was seen in 100% of patients who underwent arthroscopic release and 77% of open procedure patients. Complication rates were higher in patients undergoing an open procedure (21%) compared with an arthroscopic procedure (2.3%). This review shows a decreased failure rate, fewer complications, and decreased postoperative pain with arthroscopic management of internal snapping hip syndrome in comparison with open management. However, given the lack of high-quality evidence or direct comparison data, these results should be interpreted with caution. This review also highlights the need for the development of a standardized outcome tool for consistent reporting of clinical outcomes. Level IV, systematic review of Level IV studies.

Iliopsoas Tendon Reformation after Psoas Tendon Release

Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.

Endoscopic Release of the Iliopsoas Tendon and Iliotibial Band

Indications for endoscopic surgery of the hip have expanded recently. The technique has found a clear indication in the management of snapping hip syndromes, both the external snapping hip and the internal snapping hip. Even though the snapping hips (external and internal) share a common name, they are very different in origin. The external snapping hip is produced by the iliotibial band snapping over the prominence of the greater trochanter during flexion and extension. Indication for surgical treatment is painful snapping with failure of conservative treatment. The endoscopic technique is designed to release the iliotibial band, producing a diamond shape defect on the iliotibial band lateral to the greater trochanter. The defect allows the greater trochanter to move freely without snapping. The greater trochanteric bursa is resected through the defect, and the abductor tendons are inspected. This procedure is performed without traction, and usually only the peritrochanteric space is accessed. If necessary, hip arthroscopy can also be performed. There is limited literature regarding the results of endoscopic treatment for the external snapping hip syndrome, but early reports are encouraging. The internal snapping hip syndrome is produced by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. The snapping phenomenon usually occurs with extension of the hip from a flexed position of more that 90°. Two different endoscopic techniques have been described to treat this condition. The iliopsoas tendon is released at the level of the hip joint; with this technique, the iliopsoas bursa is accessed through an anterior hip capsulotomy and is frequently referred to as a transcapsular release. The second technique is a release at the insertion of the iliopsoas tendon on the lesser trochanter; with this technique, the iliospaos bursa is accessed directly. In every report, the iliopsoas tendon release has been combined with arthroscopy of the hip joint. It has been documented that more than half of the patients with internal snapping hip syndrome have intra-articular hip pathology. The results of endoscopic release of the iliopsoas tendon in the treatment of internal snapping hip syndrome are encouraging and seem to be better than those reported for open procedures.

Endoscopic Treatment of Snapping Hips, Iliotibial Band, and Iliopsoas Tendon

Indications for endoscopic surgery of the hip have expanded recently. The technique has found a clear indication in the management of snapping hip syndromes, both external snapping hip and internal snapping hip. Even though the snapping hips (external and internal) share a common name, they are very different in origin. The external snapping hip is produced by the iliotibial band snapping over the prominence of the greater trochanter during flexion and extension. Indication for surgical treatment is painful snapping with failure of conservative treatment. The endoscopic technique is designed to release the iliotibial band producing a diamond shape defect on the iliotibial band lateral to the greater trochanter. The defect allows the greater trochanter to move freely without snapping. The greater trochanteric bursa is resected through the defect and the abductor tendons inspected. This procedure is performed without traction and usually only the peritrochanteric space is accessed. If necessary, hip arthroscopy can also be performed. There is limited literature regarding the results of endoscopic treatment for the external snapping hip syndrome, but early reports are encouraging. The internal snapping hip syndrome is produced by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. The snapping phenomenon usually occurs with extension of the hip from a flexed position of more than 90 degree. Two different endoscopic techniques have been described to treat this condition. Iliopsoas tendon release at the level of the hip joint, with this technique the iliopsoas bursa is accessed through an anterior hip capsulotomy and is frequently referred to as a transcapsular release. The second technique is a release at the insertion of the iliopsoas tendon on the lesser trochanter, with this technique the iliospaos bursa is accessed directly. In every report the iliopsoas tendon release has been combined with arthroscopy of the hip joint. It has been documented that more than half of the patients with internal snapping hip syndrome have intra-articular hip pathology. The results of endoscopic release of the iliopsoas tendon in the treatment of internal snapping hip syndrome are encouraging and seem to be better than those reported for open procedures.

Prospective Randomized Study of 2 Different Techniques for Endoscopic Iliopsoas Tendon Release in the Treatment of Internal Snapping Hip Syndrome

To evaluate the short-term results of 2 different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. Between January 2005 and January 2007, a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized into 2 different groups. Patients in group 1 were treated with endoscopic iliopsoas tendon release at the lesser trochanter, and patients in group 2 were treated with endoscopic transcapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartments was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series, and each patient received 400 mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative Western Ontario MacMaster (WOMAC) scores and imaging studies were evaluated. Nineteen patients were included in the study: 10 in group 1 (5 male and 5 female; average age, 29.5 years) and 9 in group 2 (8 female and 1 male; average age, 32.6 years). No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, and every patient in both groups had an improvement in the WOMAC score. Improvements in WOMAC scores were statistically significant in both groups, and no difference was found in postoperative WOMAC results between groups. No complications were seen. Iliopsoas tendon release at the level of the lesser trochanter or at the level of the hip joint using a transcapsular technique is effective and reproducible. We found no clinical difference in the results of both techniques.

Prospective Randomized Study of Two Different Techniques for Endoscopic Iliopsoas Release in the Treatment of Internal Snapping Hip Syndrome (SS-06)

We compare 2 randomized groups of patients that were prospectively followed, treated for internal snapping hip symptoms using two different endoscopic techniques. Sort term results are presented. To evaluate short term results of two different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. Between January 2005 and January 2007 a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized in two different groups. Patients in group one were treated with endoscopic iliopsoas tendon release at the lesser trochanter and patients in group two were treated with endoscopic transscapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartment was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series and every patient received 400mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative WOMAC scores and imaging studies were evaluated. Nineteen patients were included in the study, 10 in group 1, 5 male and 5 female with an average age of 29.5 years and 9 in group 2, 8 female and 1 male with an average age of 32.6 years. No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, every patient en both groups presented an increment in the WOMAC score. Increments in WOMAC scores were statistically significant in both groups, no difference was found in postoperative WOMAC results between groups. No complications were seen. Different techniques for endoscopic release of the iliopsoas tendon have been recently described in the literature, we compared both techniques in prospectively in 2 series of patients that were randomized and found no difference in short-term results or complication incidence.

Commentary on “Low back pain associated with internal snapping hip syndrome in a competitive cyclistLow back pain associated with internal snapping hip syndrome in a competitive cyclist”

Low back pain is a common problem among people who cycle. This article draws attention to a source of low back pain in cyclists that was not noted previously in...

Low back pain associated with internal snapping hip syndrome in a competitive cyclist

Low back pain is a common complaint among cyclists. Here we present the case of a competitive master cyclist with low back pain and whose symptoms ultimately resolved when he...

Internal Snapping Hip Syndrome: Treatment by Endoscopic Release of the Iliopsoas Tendon

The internal snapping hip syndrome is caused by slippage of the iliopsoas tendon over the iliopectineal eminence or the femoral head. Open surgical techniques have been successfully used to treat this condition. More recently, endoscopic techniques have become available to address this problem. The purpose of this study was to investigate an endoscopic technique for release of the iliopsoas tendon and its short-term results. Consecutive case series. Six patients (7 hips) with an average age of 38.5 years had an endoscopic release of the iliopsoas tendon for internal snapping hip syndrome. Hip arthroscopy was performed in every patient. Special inferior portals were used for psoas bursoscopy. The iliopsoas tendon was identified and released at the level of the lesser trochanter in all cases. Intra-articular concomitant injuries were identified and treated in 4 cases. No snapping symptoms were present in any patient after surgery nor at the last follow-up at, on average, 21 months. Significant loss of flexion strength was present after surgery but had improved by 8 weeks. In our hands, the endoscopic technique for iliopsoas tendon release was effective and reproducible and our results compare well with results of open procedures in the short term. Level IV.

Relief of Internal Snapping Hip Syndrome in a Marathon Runner After Chiropractic Treatment

To discuss the assessment, diagnosis and chiropractic management of a patient with sacroiliac joint dysfunction (SIJ) complicated by psoas major snapping hip syndrome (coxa saltans interna). A 32-year-old male marathon runner experienced low-back and left hip pain without radiation accompanied by a "popping" in the anterior hip. He ran approximately 100 to 150 km/wk for the prior 3 years. He had stopped running for the previous 3 weeks because of worsening and consistent pain. Treatment consisted of side posture SIJ "diversified" manipulation and myofascial release to the psoas muscle twice weekly for 2 weeks. The patient was also taught proprioceptive neuromuscular facilitation exercises of the psoas and iliotibial band muscles. He was instructed to substitute swimming instead of running on a daily basis. Reassessment at 3 weeks found the patient without pain in his hip or back and no clicking or popping in his left hip. Clinicians should consider that runners who present with coexisting SIJ dysfunction and internal snapping hip syndrome may benefit from the combined management of both conditions.

Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome.

To evaluate the efficacy of both iliopsoas bursa imaging and therapeutic injections for determination of the cause of pain in patients with internal snapping hip syndrome. Twelve patients underwent iliopsoas bursa imaging. One patient underwent the procedure bilaterally and five underwent repeated studies for a total of 21 studies. Eight patients also received therapeutic injections after bursa imaging. Abnormal motion of the iliopsoas musculotendinous unit that occurred synchronously with the snap was revealed in 15 of the 21 studies. Four studies revealed additional information that contributed to symptoms. Eight patients received therapeutic injections with relief of symptoms that ranged from 2 weeks to 2 years. Iliopsoas bursa imaging is a simple, rapid, and reproducible method with which abnormal iliopsoas tendon motion can be documented in patients with internal snapping hip syndrome and is also useful for diagnosis of other causes of atypical hip pain. Therapeutic injection into the iliopsoas bursa may delay or obviate surgery.