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The limited reliability of physical examination and imaging for diagnosis of iliopsoas tendinitis

Haskel J, Kaplan D, Fried J, Youm T, Samim M, Burke C

Arthroscopy 2021 Apr;37(4):1170-1178

primary study

PURPOSE: To determine if any association exists between physical examination and/or imaging findings (ultrasound (US) and magnetic resonance imaging (MRI)) and IPT in order to characterize the reliability of these diagnostic modalities. METHODS: Patients who had undergone US-guided iliopsoas tendon sheath injection (of lidocaine and a corticosteroid agent) as well as MRI performed within one year of injection between 2014 to 2019 were retrospectively reviewed. Demographic data, response to physical exam maneuvers, and response to injection were queried from patient records. US and MRIs were reviewed by 2 independent musculoskeletal-trained radiologists. Response to injection was considered positive if the patient improved by > 2 points on a 0 to 10 VAS score. Chi-square and Fischer exact testing was utilized to assess for any associations. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated. RESULTS: Sixty-three patients, with mean age 52.3 years +/- 17.3, with average BMI 27.4 +/- 4.3, and average follow-up was 33.6 months +/- 20.6 met inclusion criteria. No physical exam maneuvers, sonographic features, or MRI findings were significantly associated with response to iliopsoas tendon injection (p > 0.05). Groin pain had a sensitivity of 100%, though a specificity of 7%. Snapping hip had a specificity of 82%, though a sensitivity of 24%. Pain with resisted SLR (sensitivity 62%, specificity 25%), and weakness with resisted SLR (sensitivity 15%, specificity 71%) both were non-reliable. Sonographic bursal distension and tendinosis had low sensitivities (67% and 63%, respectively) and specificities (35% and 32%, respectively). Bursal distension on MRI had sensitivity and specificity of 64% and 45% respectively. Tendon thickening had sensitivity and specificity of 55% and 60%, respectively, while heterogeneity had sensitivity and specificity of 52% and 65%, respectively. CONCLUSION: Neither physical examination, nor US, nor MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected IPT.
Copyright by Arthroscopy Association of North America.

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