Outcomes after fluoroscopy-guided iliopsoas bursa injection for suspected iliopsoas tendinopathy

• Published in: European radiology 2015-03, Vol.25 (3), p.865-871
• Main Authors: Agten, Christoph A., Rosskopf, Andrea B., Zingg, Patrick O., Peterson, Cynthia K., Pfirrmann, Christian W. A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bursa, Synovial; Contrast agents; Diagnostic Radiology; Female; Fluoroscopy - methods; Glucocorticoids - administration & dosage; Hip joint; Hospitals; Humans; Imaging; Injections, Intra-Articular; Internal Medicine; Interventional Radiology; Joint replacement surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Musculoskeletal; Musculoskeletal Pain - prevention & control; Neuroradiology; Pain; Pain Measurement - methods; Patients; Prospective Studies; Prostheses; Psoas Muscles; Questionnaires; Radiography, Interventional - methods; Radiology; Surveys and Questionnaires; Tendinopathy - diagnostic imaging; Treatment Outcome; Triamcinolone - administration & dosage; Ultrasound; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-014-3453-x

Objectives To report patient outcomes up to 1 month after fluoroscopy-guided iliopsoas bursa injection for suspected iliopsoas tendinopathy. Methods Thirty-nine consecutive patients (mean age 45 years; range 15–77) who underwent fluoroscopy-guided therapeutic iliopsoas bursa injection using an anterolateral approach and who returned an outcomes questionnaire were prospectively included. The Patients’ Global Impression of Change (PGIC) scale was recorded 1 day, 1 week, and 1 month after the injection (primary outcome measure). Patients’ subjective pain level data were collected prior to the injection (baseline) using a numeric rating scale (NRS; 0 = no pain; 10 = maximum pain). NRS scores were completed 15 min, 1 day, 1 week, and 1 month post-injection and compared to baseline. Results Forty-nine per cent of patients reported clinically relevant ‘improvement’ (PGIC) 1 month post-injection. Mean NRS score prior to injection was 5.9 ± 2.1. Mean NRS scores after 15 min (3.6 ± 2.7), 1 day (4.4 ± 2.7), 1 week (3.4 ± 1.9), and 1 month (3.5 ± 2.5) were statistically significantly lower ( p  ≤ 0.001) compared to baseline. Reduction of NRS ≥50 % after 15 min was achieved in 49 % (56 % of those unimproved at 1 month). Conclusions Fluoroscopy-guided iliopsoas bursa injection leads to a relevant ‘improvement’ at 1 month or significant pain reduction after 15 min in most patients. Key points • Fluoroscopy-guided iliopsoas bursa injection is a safe procedure. • Most patients had a diagnostic or therapeutic benefit from the injection. • The anterolateral approach may reduce the risk of damage to the neurovascular bundle. • The procedure is eligible for patients with and without total hip arthroplasty.