Abstract
Aim
Iliopsoas tendinopathy occurs due to friction of the iliopsoas tendon on the iliopectineal bar or the hip capsule causing pain and snapping of the hip. In adolescent cases this condition is generally treated conservatively with physiotherapy, stretching and NSAIDs. Our aim was to study the outcome of non-operative management of iliopsoas tendinopathy.
Method
A retrospective 4-year study identified adolescent patients with a clinical diagnosis of psoas tendinopathy managed non-operatively. These patients were followed up by postal questionnaire, which included functional assessment using the Non-Arthritic Hip Score (NAHS). A custom study questionnaire assessed current symptoms and the effects of physiotherapy. All patients not treated conservatively were removed from the study.
Results
36 patients were treated conservatively for psoas tendinopathy. 28 completed and returned the questionnaires to a satisfactory standard. Mean NAHS was 77.72 (CI: 69.91 to 85.54) at a mean follow up of 37 months (Range: 14 to 58 months; CI 31 to 43 months). Pain was the least disabling NAHS domain at final follow up with a significant improvement over the follow up period (p<0.001). 11 patients suffered from recurrence of symptoms (clicking, stiffness, decreased range of motion). 7 patients (25%) complained of significant pain following conservative management. A Numbers Needed to Treat analysis (NNT) was performed, comparing our data with that of surgically managed patients in previously published studies. This analysis suggests that for every 6 surgical releases, 5 would have recovered anyway with non-operative management.
Conclusion
Non-operative management is successful in managing psoas tendinopathy in about 75% of adolescent patients. It is especially effective in males, and patients who are more active prior to development of symptoms.
