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Musculoskeletal ultrasound (MSK-US) has become an increasingly valuable tool in the evaluation and management of soft tissue and joint pathologies, particularly for rehabilitation providers. This article highlights the use of MSK-US for assessing the iliopsoas tendon and musculature in the anterior hip. The iliopsoas complex is often implicated in conditions such as tendinitis, snapping hip syndrome, and hip flexor strains, and accurate assessment can be challenging due to its deep anatomical location. MSK-US offers a safe, cost-effective, and dynamic modality for visualizing the iliopsoas, providing crucial insights into its morphology, pathology, and response to rehabilitation interventions. This paper discusses the anatomy of the iliopsoas, ultrasound scanning techniques, common findings, and the clinical relevance of MSK-US in rehabilitation settings. This paper explores the efficacy of MSK-US in the assessment of the iliopsoas muscle and tendon and underscores its utility in diagnosing iliopsoas-related abnormalities such as tendinopathy and bursitis. [ABSTRACT FROM AUTHOR]

Background The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. Purpose/Hypothesis This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Study Design Intra- and inter-rater reliability study Methods Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. Results The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. Conclusion These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) describe iliopsoas activation levels during common rehabilitation exercises and (2) provide an evidence-based exercise progression for strengthening the iliopsoas based on electromyography (EMG) studies. Methods: In total, 109 healthy adult participants ranging from ages 20 to 40 were included in nine studies. PubMed, CINAHL, and Embase databases were systematically searched for EMG studies of the psoas, iliacus, or combined iliopsoas during specific exercise. The Modified Downs and Black Checklist was used to perform a risk of bias assessment. PROSPERO guidelines were followed. Results: Nine studies were included. Findings suggest that the iliopsoas is increasingly activated in ranges of hip flexion of 30–60°, particularly with leg lowering/raising exercises. Briefly, >60% MVIC activity of the iliopsoas was reported in the active straight leg raise (ASLR) in ranges around 60° of hip flexion, as well as with supine hip flexion and leg lifts. In total, 40–60% MVIC was found in exercises including the mid-range of the ASLR around 45° of hip flexion and lifting a straight trunk while in a hip flexed position. Conclusions: The findings suggest that exercises in increased hip flexion provide greater activation of the iliopsoas compared to exercises where the trunk is moving on the lower extremity. Iliopsoas activation can be incrementally progressed from closed to open kinetic chain exercises, and eventually to the addition of external loads. The proposed exercise program interprets the results and offers immediate translation into clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To assess risk factors of retroperitoneal and lower extremity musculoskeletal bleed in acquired haemophilia (AHA) and perform an objective assessment of disability and influence on survival. Methods: We included 49 patients with AHA from November 2017 to May 2023. The occurrence of any retroperitoneal or/and lower extremities bleeding manifestation was investigated. On clinical follow‐up, we search for compressive femoral neuropathy and quadriceps amyotrophy. The lower extremity functional scale (LEFS) was carried out one year after the last bleeding event in all AHA patients. Results: A 61.2% of patients in our AHA cohort presented with any retroperitoneal and/or lower extremities musculoskeletal manifestation. Those patients had higher percentage of major bleeding EACH2/ISTH criteria (90% vs. 57%, p =.01), needs of blood transfusions (86% vs. 57% of patients, p =.03), and haemostatic by‐pass products (90% vs. 63%, p =.02). Hypertension (HR 2.6, 95% CI 1.1–5.9, p =.02), presence of autoimmune disease (HR 13, 95% CI 1.7–99, p =.01), and inhibitor level > 20 BU (HR 2.6 95% CI 1.0–6.8, p =.04) significantly predicted retroperitoneal/lower extremities clinical manifestations. Most frequent sequelae were quad atrophy (30.6%) and femoral nerve palsy (20.4%). Quad atrophy and LEFS scores under 50 were associated with increased mortality (HR 3, 95% CI 1.1–8.6 and HR 12, 95% CI 3.3–45, respectively). Conclusion: AHA with retroperitoneal/lower extremities bleeding involvement is of greater severity and shows high disability and worst survival outcomes. Quadriceps atrophy and LEFS scale scoring under 50 predicted mortality in our AHA patients. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate the functional outcome during follow-up (FU) after endoscopic tenotomy for iliopsoas (IP)-cup impingement and to quantitatively analyze the hip flexion strength. Methods: This was a monocentric, retrospective cohort study of a single surgeon series. Functional assessment was based on the modified Harris score, the Oxford score and the visual analog scale score. Strength was measured with a handheld dynamometer in the sitting and lying position. Results: Thirty-six IP tenotomies for cup impingement were performed between May 2013 and November 2021. Seven (19%) patients were lost to FU. At the time of tenotomy, the mean (standard deviation) age was 62,6 (12,2) and BMI was 26,5 (4,1). The mean FU time after tenotomy to the last FU was 3,6 (0,8) years. All three outcome scores improved from preoperatively to six months postoperatively (p < 0.001). There were no significant change from six months to last FU. The minimal clinically important difference (MCID) of the modified Harris score was set at 25. 20 (69%) patients had values that exceeded the threshold at one month and six months and neutral 19 (65.5%) had values that exceeded the threshold at the last FU. The limp symmetry index concerning hip flexion strength was 63% at 90° and 40% at 30° at the last FU. Conclusion: Most patients significantly improved their outcome scores after endoscopic iliopsoas tenotomy, with results remaining consistently stable over time. Despite a significant loss in hip flexion strength, the majority of patients did not report any impairment of their quality of life. Study design: Level III, Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Abstract Background While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship (“Primavera 1”). Results Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p

Background: While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship ("Primavera 1"). Results: Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p < 0.0001). Conclusions: The study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship. Key points: • In the Italian male elite Under-19 football Championship, each Club can expect around 15 non-contact muscle injuries during the season (for a team of 25 players) distributed as follows: 6 hamstrings, 3 quadriceps, 2 adductors, 2 calf and 1 iliopsoas muscle injuries. • Hamstrings injury incidence and burden (both in training sessions and during matches), as well as the proportion of reinjuries, were found to be the highest among muscle sites. • Injuries to adductors and calf muscles exhibited comparable values of incidence and burden. • Iliopsoas emerged as a noteworthy site of injury in the current cohort, particularly during training sessions. • Aponeurosis or tendon damage was associated with longer return to football timing, particularly in hamstrings and adductors injuries. [ABSTRACT FROM AUTHOR]

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Ischiofemoral injuries are very rare and their importance is underestimated. The ischiofemoral injuries include avulsion fractures of the lesser trochanter and the ischial tuberosity, rupture or injury of the quadratus femoris muscle and rupture or injury of the iliopsoas tendon. As a rule, conservative therapy is carried out, although in individual cases surgical treatment must be considered. As a result of an ischiofemoral injury, ischiofemoral impingement can occur. On the other hand, ischiofemoral impingement can lead to an injury or rupture of the quadratus femoris muscle. [ABSTRACT FROM AUTHOR]

Background and purpose: The diagnosis of functional neurological disorder should be actively made based on the neurological signs. We described two new complementary signs to diagnose functional weakness of the lower limb, "weak gluteus maximus (weak GM)" and "weak Iliopsoas with normal gluteus maximus (weak iliopsoas with normal GM)," and tested their validity. Methods: The tests comprised Medical Research Council (MRC) examinations of the iliopsoas and GM in the supine position. We retrospectively enrolled patients with functional weakness (FW) or structural weakness (SW) who presented with weakness of either iliopsoas or GM, or both. Weak GM means that the MRC score of GM is 4 or less. Its complementary sign, weak ilopsoas with normal GM, means that the MRC score of ilopsoas is 4 or less, whereas that of GM is 5. Results: Thirty‐one patients with FW and 72 patients with SW were enrolled. The weak GM sign was positive in all 31 patients with FW and in 11 patients with SW, that is, 100% sensitivity and 85% specificity. Therefore, the complementary sign, weak iliopsoas with normal GM, was 100% specific for SW. Discussion: Although 100% should be discounted considering limitations of this study, these signs will likely be helpful in differentiating between FW and SW in the general neurology setting. Downward pressing of the lower limb to the bed in the supine position is interpreted by the patient as an active movement exerted with an effort and might be preferentially impaired in FW. [ABSTRACT FROM AUTHOR]

الملخص: الخلفية: مرضى كوفيد-19 ذوي الحالات الحرجة لديهم مخاطر أعلى للإصابة بحالات فرط التخثر. في الوقت الحالي، تم إعطاء العديد من مرضى COVID-19 مضادات التخثر أو العلاجات المضادة للصفيحات لتقليل خطر تجلط الدم المنتظم. الورم الدموي في العضلة القطنية هو أحد المضاعفات القاتلة والنادرة لاضطرابات النزيف أو العلاج المضاد للتخثر والذي يتطور أحيانا ليصبح مهما سريريا. الغرض الرئيسي من مراجعة الحالة هذه هو التأكيد على أهمية تشخيص أورام العضلة القطنية الدموية وإمكانية مساهمة مضادات الصفيحات في تطورها. عرض الحالة: نعرض هنا حالة نادر لورم دموي في العضلة القطنية غير رضحي في مريض لا يتناول مضاد للتخثر. المريض رجل يبلغ من العمر 59 عاما، مصاب بمرض السكري من النوع الثاني، ويتناول أدوية سكر الدم عن طريق الفم، بعد 3 أسابيع من الإصابة بكوفيد-19. كان قد بدأ تناول الأسبرين 81 ملغ عن طريق الفم، مرة واحدة يوميا، للوقاية من الأحداث التخثرية المرتبطة بعدوى كوفيد-19، دون استخدام مضادات التخثر ولا أدوية أخرى. قدم المريض إلى قسم الطوارئ، يشتكي من ضعف الطرف الأيمن التدريجي لمدة أسبوعين، وقد تم تأكيد تشخيص الورم الدموي في العضلة القطنية بناءً على الفحص الإشعاعي. الاستنتاجات: ينبغي النظر في إمكانية حدوث ورم دموي في العضلة القطنية في المرضى الذين لا يستخدمون مضادات للتخثر ولا يعانون من اضطرابات تخثر وراثية أو مكتسبة، ويشتكون من ضعف في الأطراف. يجب دراسة الصلة بين استخدام مضادات الصفيحات في مريض كوفيد -19 وتطور نزيف الأنسجة الرخوة (مثل الورم الدموي في العضلة القطنية). Abstract: Background: Critically ill COVID-19 patients have an elevated risk of experiencing hypercoagulable conditions. Currently, many COVID-19 patients have been administered anticoagulation or antiplatelet therapies to lower the risk of systematic thrombosis. Iliopsoas hematoma is a potentially fatal and rare complication of bleeding disorders or anticoagulation therapy which sometimes grows to become clinically significant. The main purpose of this case review is to emphasize the importance of diagnosing iliopsoas hematomas and the possibility of antiplatelet contribution to its development. Case Presentation: We are reporting a rare presentation of non-traumatic iliopsoas hematoma in a non-anticoagulated patient. The patient is a 59-year-old male, with known type-2 diabetes, on oral hypoglycemic medications, 3-weeks post-COVID-19. He had started aspirin 81 mg orally, once daily, to prevent thrombotic events associated with COVID 19 infection, with no anticoagulant use and no other medications. He came in through the ED, presenting with two weeks history of progressive right lower limb weakness in which an iliopsoas hematoma diagnosis was confirmed based on radiological investigation. Conclusion: The possibility of iliopsoas hematoma should be considered in non-anticoagulated patients with no inherited or acquired coagulation disorders presenting with limb weakness. The link between antiplatelet use in a COVID-19 patient and the development of soft tissue bleeding (e.g., iliopsoas hematoma) must be studied further.

We report two cases of traumatic iliopsoas hemorrhage, without hemoperitoneum, initially detected by ultrasound. Flexion hip contracture in the first case and incomplete femoral nerve palsy in the second case alerted the sonographer to the possibility of traumatic iliopsoas hemorrhage. The first case involved a 54-year-old man who complained of progressive right flank pain and difficulty in walking after falling to the ground. The second case involved a 34-year-old man who complained of severe lower back pain and numbness and weakness of the left leg after a motorcycle accident. In both cases, iliopsoas hemorrhage was confirmed on subsequent multidetector computed tomography.

Abstract Background and purpose The diagnosis of functional neurological disorder should be actively made based on the neurological signs. We described two new complementary signs to diagnose functional weakness of the lower limb, “weak gluteus maximus (weak GM)” and “weak Iliopsoas with normal gluteus maximus (weak iliopsoas with normal GM),” and tested their validity. Methods The tests comprised Medical Research Council (MRC) examinations of the iliopsoas and GM in the supine position. We retrospectively enrolled patients with functional weakness (FW) or structural weakness (SW) who presented with weakness of either iliopsoas or GM, or both. Weak GM means that the MRC score of GM is 4 or less. Its complementary sign, weak ilopsoas with normal GM, means that the MRC score of ilopsoas is 4 or less, whereas that of GM is 5. Results Thirty‐one patients with FW and 72 patients with SW were enrolled. The weak GM sign was positive in all 31 patients with FW and in 11 patients with SW, that is, 100% sensitivity and 85% specificity. Therefore, the complementary sign, weak iliopsoas with normal GM, was 100% specific for SW. Discussion Although 100% should be discounted considering limitations of this study, these signs will likely be helpful in differentiating between FW and SW in the general neurology setting. Downward pressing of the lower limb to the bed in the supine position is interpreted by the patient as an active movement exerted with an effort and might be preferentially impaired in FW.

Introduction. Labral tears (LT) can present with hip or groin pain. Investigation of LT is typically with Magnetic Resonance Arthrography (MRA). The injection of contrast for MRA can lead to fluid signal intensity/oedema on fluid sensitive sequences within the iliopsoas muscle and tendon complex masking the diagnosis of iliopsoas tendinopathy, which may present with similar symptoms. The aim of this study was to identify the presence of iliopsoas oedema in young adult patients being investigated for LT. Material and methods. We performed a retrospective search of our radiology system for the word ‘labral tear’ in the reports of patients who had MRI between 2012 to 2018. Patients under the age of 40 years who underwent high resolution dedicated hip MRI were included in our study. From this database, we then used a keyword search ‘strain and (o)edema’ to identify cases of iliopsoas pathology and analysed the results. Results. We identified 1151 consecutive cases of high resolution hip MRI with a suspected labral tear. 503 patients under the age of 40 years were included in our study with the average age of 27 years. Of the 503 patients within our cohort, searching for the word ‘strain’ identified 48 (9.5%) cases. Of these, 26 (5.3%) patients had iliopsoas oedema with a labral tear. 22 (4.4%) patients had iliopsoas oedema without a labral tear. Conclusion. Our study shows that 4.4% of patients undergoing MRA have no labral tears but iliopsoas oedema. Patients should undergo MRI to exclude iliopsoas strains before MRA.

We report two cases of traumatic iliopsoas hemorrhage, without hemoperitoneum, initially detected by ultrasound. Flexion hip contracture in the first case and incomplete femoral nerve palsy in the second case alerted the sonographer to the possibility of traumatic iliopsoas hemorrhage. The first case involved a 54-year-old man who complained of progressive right flank pain and difficulty in walking after falling to the ground. The second case involved a 34-year-old man who complained of severe lower back pain and numbness and weakness of the left leg after a motorcycle accident. In both cases, iliopsoas hemorrhage was confirmed on subsequent multidetector computed tomography. [ABSTRACT FROM AUTHOR]

Hypaxial muscle abscess is an important differential in dogs presenting for abdominal or back pain, lameness, and nonspecific signs like fever, lethargy, and hyporexia. It can occur concurrently with intrathoracic disease such as pyothorax secondary to migrating vegetal foreign material. Twelve dogs that underwent CT of the lumbar spine or abdomen and had a diagnosed hypaxial abscess on surgical and/or microbiological examination were included in this retrospective, descriptive case series. Computed tomography findings and findings from other imaging modalities employed were described. Eleven dogs were hunting breeds. Clinical signs included lethargy, fever, increased respiratory effort, and abdominal or back pain. Radiography and/or ultrasonography were employed during preliminary work up at clinician discretion and respectively revealed changes consistent with osteomyelitis in the cranial lumbar vertebrae and heterogenous, hypoechoic areas in the hypaxial musculature consistent with abscesses. Computed tomography findings included enlargement of hypaxial muscles with well‐defined fluid attenuating noncontrast enhancing areas with a contrast‐enhancing rim consistent with abscesses, periosteal reaction and lysis of vertebrae, and retroperitoneal effusion. Four of the 12 cases in this series had material identified and removed at surgery. The other eight cases were presumed to be the same disease process based on compatible signalment, imaging findings, and microbiological results. Migrating vegetal foreign bodies are a common problem at the authors' institution. Computed tomography provided expedient, thorough visualization of the relevant hypaxial lesions for diagnostic and surgical planning purposes and also characterized intrathoracic components of this disease. [ABSTRACT FROM AUTHOR]

Case: A 40-year-old man presented with spontaneous, atraumatic right groin pain and inability to bear weight secondary to an isolated avulsion of the right lesser trochanter. Magnetic resonance imaging of the affected hip was suggestive of an infection, and a computed tomography–guided biopsy was remarkable for Mycobacterium tuberculosis , which was successfully managed with antitubercular therapy and activity modification. Conclusion: Although an isolated spontaneous avulsion of the lesser trochanter is typically pathognomonic for malignancy, an infectious etiology, such as tuberculosis, should also be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Hip pain is common in patients of advanced age and has a very broad differential. Of the potential aetiologies, iliopsoas tendon ruptures are rare. Consequently, there is a paucity of literature on iliopsoas rupture in the older adult population, and its rarity can lead to a delay in its diagnosis. When iliopsoas ruptures do occur, they are typically secondary to trauma; however, they can occur spontaneously. Iliopsoas injuries can be disabling, but they respond well to conservative management. We report here a case of a 70-year-old woman who presented to an unaffiliated emergency department with left anterior hip pain 2 weeks after a fall from standing height. Results: Initial X-ray and computed tomography were negative for fracture, and the patient was discharged with home health physical therapy. Her symptoms persisted. At a subsequent emergency department visit several weeks later, magnetic resonance imaging revealed a complete left iliopsoas tendon rupture with retraction. She was treated conservatively and made a complete recovery after physical therapy. Discussion: This paper reviews the literature related to iliopsoas injuries, highlights the importance of iliopsoas tendon injuries among the differential for acute hip pain, and provides management recommendations for this rare, but probably underdiagnosed, injury. This treatable condition warrants further attention, as delay in diagnosis can prolong morbidity. LAY ABSTRACT Hip pain is common in the elderly population and has many causes. Of the potential sources of hip pain, a complete tear of the iliopsoas, or hip flexor, tendon is rare. When iliopsoas tears do occur, it is typically after trauma, such as a fall. However, tears can happen spontaneously. Diagnosis is best made using magnetic resonance imaging (MRI), but can be made with ultrasound. These injuries can be disabling, but respond well to conservative management consisting of rest and pain management principles, followed by physical therapy active rehabilitation. This paper reviews the literature on iliopsoas tears, provides management recommendations for this rare, but probably underdiagnosed, injury, and reports a case of a 70-year-old woman who experienced a complete iliopsoas tear after a fall from standing height. The diagnosis was missed on initial evaluation, and was subsequently made using MRI. The patient made a full recovery after conservative management.