Ultrasound-Guided Cortisone Injection for Iliopsoas Tendinopathy and Bursitis

 

Introduction

Hip and groin pain can significantly affect movement, daily activities, and quality of life. Among the many possible causes, iliopsoas tendinopathy and iliopsoas bursitis are commonly encountered conditions. Both affect the deep structures of the hip and can be particularly challenging to diagnose without detailed assessment. At Joint Injections, our clinicians provide ultrasound-guided cortisone injections for patients with iliopsoas-related pain, aiming to target the source of discomfort precisely.

This blog will explore iliopsoas tendinopathy and bursitis in detail, including anatomy, pathology, clinical features, diagnostic approaches, and management options. We will also explain the role of cortisone injections, their mechanism of action, and how ultrasound guidance enhances the accuracy and safety of the procedure.

Anatomy of the Iliopsoas Complex

The iliopsoas is a powerful hip flexor composed of two main muscles:

  • Psoas major — originating from the lumbar vertebrae.
  • Iliacus — arising from the inner surface of the pelvis.

These muscles join to form a common tendon that inserts onto the lesser trochanter of the femur.

Beneath this tendon lies the iliopsoas bursa, one of the largest bursae in the body. Its function is to reduce friction between the iliopsoas tendon and the underlying hip joint structures. Inflammation of either the tendon or the bursa can give rise to significant anterior hip and groin pain.

Pathology of Iliopsoas Tendinopathy

Iliopsoas tendinopathy refers to irritation or degeneration of the iliopsoas tendon. Common contributing factors include:

  • Overuse or repetitive strain from activities such as running, kicking, or climbing stairs.
  • Sudden increases in physical activity without adequate conditioning.
  • Muscle imbalances or poor biomechanics, leading to increased load on the tendon.
  • Post-surgical changes, especially after hip replacement, where altered mechanics can stress the tendon.

Over time, microscopic tears, collagen degeneration, and inflammation can develop within the tendon, producing pain and dysfunction.

Pathology of Iliopsoas Bursitis

Iliopsoas bursitis occurs when the bursa becomes inflamed, usually due to repetitive hip flexion or secondary to adjacent tendon irritation. It may also develop in association with underlying hip joint pathology, such as labral tears or arthritis.

When inflamed, the iliopsoas bursa can enlarge, causing pain and sometimes a palpable swelling in the groin. In severe cases, it may interfere with mobility and lead to snapping or clicking sensations around the hip.

Clinical Features

Symptoms of iliopsoas tendinopathy and bursitis often overlap, making clinical differentiation challenging. Common features include:

  • Pain in the anterior hip or groin, sometimes radiating down the thigh.
  • Discomfort when climbing stairs, rising from a chair, or performing sit-ups.
  • A sensation of snapping or clicking in the hip with movement.
  • Stiffness and reduced hip flexibility.
  • Pain aggravated by resisted hip flexion.

Diagnosis

Diagnosis requires a thorough clinical assessment, often supported by imaging.

  • Physical examination — clinicians may assess hip range of motion, muscle strength, and reproduction of pain during resisted hip flexion.
  • Ultrasound imaging — useful for visualising tendon thickening, fluid within the bursa, and dynamic snapping during movement.

Management Approaches

Management of iliopsoas tendinopathy and bursitis typically begins with non-invasive approaches:

  • Activity modification to reduce strain on the hip.
  • Pain relief measures, such as rest, ice, or simple analgesics.

When symptoms persist despite conservative measures, ultrasound-guided cortisone injections may be considered to target inflammation directly within the tendon sheath or bursa.

Cortisone Injections for Iliopsoas Tendinopathy and Bursitis

Cortisone injections are frequently used in musculoskeletal medicine to manage inflammation. In the case of iliopsoas-related pain, injections can be delivered into the iliopsoas tendon sheath or iliopsoas bursa depending on the primary site of pathology.

At Joint Injections, these injections are always performed under ultrasound guidance, which allows clinicians to:

  • Identify the exact location of the iliopsoas tendon and bursa.
  • Deliver cortisone with precision to the affected structure.
  • Reduce the risk of injury to surrounding vessels and nerves.

Mechanism of Action of Cortisone

Cortisone is a corticosteroid medication with strong anti-inflammatory properties. Once injected into the affected area, cortisone works by:

  • Reducing the activity of inflammatory cells that accumulate within irritated tissues.
  • Decreasing swelling and fluid formation within the bursa.
  • Inhibiting chemical mediators of pain, thereby lessening sensitivity in the tendon and surrounding structures.
  • Breaking the cycle of pain and inflammation, allowing improved mobility and facilitating rehabilitation.

By targeting inflammation directly at its source, cortisone injections can provide a period of symptom relief that supports physiotherapy and functional recovery.

Role of Ultrasound Guidance

Ultrasound guidance plays a crucial role in ensuring accuracy and safety. The iliopsoas tendon and bursa lie deep within the pelvis and are surrounded by important vascular and neural structures. Using real-time ultrasound, clinicians at Joint Injections can visualise the needle path, confirm placement, and ensure the medication is delivered precisely where intended.

Why Choose Joint Injections?

At Joint Injections, our focus is on precision, safety, and patient-centred care. By combining advanced imaging with specialist expertise, our clinicians tailor treatment plans to the individual’s needs. Ultrasound-guided cortisone injections for iliopsoas tendinopathy and bursitis are performed with accuracy to ensure that therapy is directed to the correct anatomical structure.

Conclusion

Iliopsoas tendinopathy and bursitis are important causes of hip and groin pain that can affect mobility and quality of life. Accurate diagnosis and targeted management are essential for addressing these conditions effectively.

Ultrasound-guided cortisone injections, provided at Joint Injections, represent one of the interventional options available when symptoms persist despite conservative treatment. By reducing local inflammation and pain, these injections can play an important role in restoring comfort and enabling rehabilitation.

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