Ultrasound-Guided Cortisone Injection for Iliopsoas Tendinopathy and Bursitis at Alton Pain Clinic

 

Introduction

Hip and groin pain can interfere with daily movement, exercise, and overall comfort. Among the possible causes, iliopsoas tendinopathy and iliopsoas bursitis are particularly significant, often producing deep anterior hip pain that can be difficult to manage. At Alton Pain Clinic, our clinicians offer ultrasound-guided cortisone injections to help target the source of inflammation with precision.

This blog will explore the iliopsoas tendon and bursa in detail, including their anatomy, pathology, symptoms, diagnosis, and treatment options. We will also explain the role of cortisone injections, their mechanism of action, and the importance of ultrasound guidance in ensuring safe and accurate delivery.

Anatomy of the Iliopsoas Complex

The iliopsoas is the main flexor of the hip, composed of two muscles:

• Psoas major, which originates from the lumbar spine.
• Iliacus, which arises from the inner surface of the pelvis.

These muscles combine into a common tendon that attaches to the lesser trochanter of the femur.

Situated beneath this tendon is the iliopsoas bursa, a fluid-filled sac that reduces friction between the tendon and the hip joint capsule. Inflammation of either the tendon or the bursa can produce pain, stiffness, and reduced mobility.

Pathology of Iliopsoas Tendinopathy

Iliopsoas tendinopathy refers to irritation or degeneration of the iliopsoas tendon. Contributing factors may include:

• Repetitive hip flexion during sports such as running or football.
• Rapid changes in activity level without conditioning.
• Imbalances in muscle strength or biomechanics.
• Post-surgical changes following hip replacement procedures.

Over time, the tendon may develop microscopic damage and thickening, resulting in pain and restricted movement.

Pathology of Iliopsoas Bursitis

The iliopsoas bursa can become inflamed due to friction, overuse, or secondary irritation from the tendon itself. In some cases, it occurs alongside underlying hip joint issues such as labral tears or arthritis.

When inflamed, the bursa may enlarge, producing anterior hip pain and sometimes a sensation of clicking or snapping during movement.

Clinical Features

Symptoms of iliopsoas tendinopathy and bursitis often overlap. Common features include:

• Pain in the front of the hip or groin, sometimes radiating down the thigh.
• Discomfort when rising from sitting, climbing stairs, or lifting the leg.
• Clicking or snapping sensations with hip movement.
• Stiffness and reduced hip flexibility.
• Pain during resisted hip flexion.

Diagnosis

A thorough diagnostic process is essential. At Alton Pain Clinic, this usually involves:

• Clinical examination — assessing hip strength, flexibility, and movement patterns.
• Ultrasound scanning — visualising the tendon and bursa in real time, and detecting thickening or fluid accumulation.

Management Approaches

Treatment for iliopsoas tendinopathy and bursitis is typically staged, beginning with conservative strategies such as:

• Activity modification to reduce repetitive strain.
• Ice and simple pain relief to manage symptoms.

If symptoms continue despite these measures, ultrasound-guided cortisone injections may be considered to target inflammation directly in the tendon sheath or bursa.

Cortisone Injections for Iliopsoas Conditions

Cortisone is a corticosteroid medication used in musculoskeletal care for its anti-inflammatory properties. For iliopsoas-related conditions, injections can be delivered into the tendon sheath or bursa depending on the site of irritation.

At Alton Pain Clinic, injections are always performed under ultrasound guidance, allowing clinicians to:

• Visualise the iliopsoas tendon and bursa clearly.
• Guide the needle with precision.
• Minimise risk to nearby blood vessels and nerves.
• Deliver medication exactly where it is needed.

Mechanism of Action of Cortisone

Cortisone works at the cellular level to reduce inflammation and irritation. Once injected, it:

• Suppresses inflammatory cell activity.
• Decreases swelling and fluid in the bursa.
• Reduces the release of pain-related chemicals in tissues.
• Helps interrupt the cycle of pain and inflammation, enabling improved movement and rehabilitation.

Importance of Ultrasound Guidance

Because the iliopsoas structures are located deep within the hip and close to important blood vessels and nerves, accuracy is vital. Ultrasound provides real-time imaging, allowing clinicians to place the injection precisely and observe the medication dispersing in the correct area.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we focus on combining clinical expertise with advanced imaging technology. Our clinicians use ultrasound guidance to ensure precision, with treatment tailored to the specific needs of each patient. The aim is always to deliver care in a safe, accurate, and patient-centred manner.

Conclusion

Iliopsoas tendinopathy and bursitis are common causes of hip and groin pain that can limit mobility and reduce comfort. Accurate diagnosis and targeted treatment are essential for managing these conditions effectively.

Ultrasound-guided cortisone injections, performed at Alton Pain Clinic, are one of the options available when conservative treatments are insufficient. By directly addressing local inflammation, these injections can support recovery and improve day-to-day function.