Primary iliopsoas bursography in the diagnosis of disorders of the hip.

The iliopsoas bursa is a well-defined anatomic structure that has been involved in various diseases about the hip, including osteoarthritis, rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Demonstration of the iliopsoas bursa using contrast material has been reported during hip arthrography and inadvertently during angiography, but no direct or primary methods of iliopsoas bursography have been reported. A technique of primary bursography under fluoroscopy is described wherein filling of the bursa with contrast material allowed the observation of movement of the iliopsoas musculotendinous unit across the front of the pelvis during motion of the hip. This technique, which was of significant benefit in determining the etiology of two cases of the snapping hip syndrome of the internal variety, is simple, easily reproducible, and has clinical application.

The snapping hip syndrome.

The snapping hip syndrome is a symptom complex characterized by hip pain and an audible snapping of the hip with exercise typically seen in young individuals. "External" and "internal" etiologies have been described, although the "internal" etiology is poorly understood. A clinical, radiographic, and anatomical study of eight patients with this disorder, secondary to an internal etiology, was undertaken to aid in the diagnosis and surgical treatment. Iliopsoas bursography with cineradiography revealed subluxation of the iliopsoas tendon to be an apparent cause of the snapping hip. The anatomy of the hip in relationship to the iliopsoas tendon is defined with the anterior inferior iliac spine, iliopectineal eminence, and lesser trochanter assuming a significant role in the syndrome. An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resection of a lesser trochanteric bony ridge, if involved, is described.