The snapping iliopsoas tendon: New mechanisms using dynamic sonography

OBJECTIVE. The purpose of our study was to describe new mechanisms responsible for the snapping iliopsoas tendon using dynamic sonography. MATERIALS AND METHODS. We reviewed the video recordings obtained during dynamic sonography studies used to establish the diagnosis of 18 snapping iliopsoas tendons in 14 patients (nine females and five males; age range, 13-50 years) who presented clinically with either unilateral (n = 10) or bilateral (n = 4) snapping hips. During dynamic imaging, the transducer was positioned in a transverse oblique plane just above the hip joint parallel to the pubic bone. For all patients, the hip movement that generated the snapping consisted of bringing the hip from flexion-abduction-external rotation back to the neutral position. RESULTS. In 14 of 18 hips, the snapping was provoked by the sudden flipping of the iliopsoas tendon around the iliac muscle, allowing abrupt contact of the tendon against the pubic bone and producing an audible snap. Other causes of snapping iliopsoas tendon were bifid tendon heads flipping over one another (n = 3) and iliopsoas tendon impinging over an anterior paralabral cyst (n = 1). CONCLUSION. New mechanisms of snapping iliopsoas tendon have been described using dynamic sonography. Sudden iliopsoas tendon flipping over the iliac muscle was the most common cause of snapping hip.