Abstract
Patients with iliopectineal bursitis frequently complain of pain in the anterior hip and groin. The pain is localized to the area just below the crease of the groin anteriorly, with referred pain noted in the hip joint and anterior pelvis. Often, patients are unable to sleep on the affected hip and may complain of a sharp “catching” sensation with range of motion of the hip. Iliopectineal bursitis often coexists with arthritis of the hip joint.
Physical examination may reveal point tenderness in the upper thigh just below the crease of the groin. Passive flexion, adduction, and abduction, as well as active resisted flexion and adduction of the affected lower extremity, can reproduce the pain. Sudden release of resistance during this maneuver may cause an exacerbation of the patient’s pain.
Keywords
iliopectineal bursitis, septic bursitis, groin pain, hip pain, diagnostic ultrasonography, ultrasound guided injection, overuse injuries, aseptic necrosis of the femoral head
ICD-10 CODE M70.70
The Clinical Syndrome
Bursae are formed from synovial sacs, whose purpose is to allow the easy sliding of muscles and tendons across one another at areas of repetitive movement. Lining these synovial sacs is a synovial membrane invested with a network of blood vessels that secrete synovial fluid. With overuse or misuse, the bursa may become inflamed or, rarely, infected; inflammation of the bursa results in an increase in the production of synovial fluid that causes swelling of the bursal sac. Although significant interpatient variability exists in the number, size, and location of bursae, the iliopectineal bursa generally lies between the psoas and iliacus muscles and the iliopectineal eminence. This bursa may exist as a single bursal sac or, in some patients, as a multisegmented series of loculated sacs.
The iliopectineal bursa, which is also known as the limbo dancer’s bursa, is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries often involve direct trauma to the bursa through hip injuries ( Fig. 100.1 ); overuse injuries may also occur, such as the use of exercise equipment for lower extremity strengthening. If inflammation of the iliopectineal bursa becomes chronic, calcification may occur.
Signs and Symptoms
Patients with iliopectineal bursitis frequently complain of pain in the anterior hip and groin. The pain is localized to the area just below the crease of the groin anteriorly, with referred pain noted in the hip joint and anterior pelvis. Often, patients are unable to sleep on the affected hip and may complain of a sharp “catching” sensation with range of motion of the hip. Iliopectineal bursitis often coexists with arthritis of the hip joint.
Physical examination may reveal point tenderness in the upper thigh just below the crease of the groin. Passive flexion, adduction, and abduction, as well as active resisted flexion and adduction of the affected lower extremity, can reproduce the pain. Sudden release of resistance during this maneuver causes a marked increase in pain.
Testing
Plain radiographs or computed tomography scanning may reveal calcification of the bursa and associated structures that is consistent with chronic inflammation ( Fig. 100.2 ). Magnetic resonance and ultrasound imaging of the hip and pelvis are indicated if tendinitis, partial disruption of the ligaments, stress fracture, internal derangement of the hip, or pelvic mass is suspected as well as to confirm the diagnosis ( Fig. 100.3 ). Ultrasonography may confirm the cystic nature of the structures ( Fig. 100.4 ). Radionuclide bone scanning is indicated if occult fracture, metastatic disease, or primary tumor involving the hip or pelvis is being considered. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
