Ultrasound-guided infiltration of the Iliopsoas complex

What is ultrasound-guided injection of the iliopsoas complex?

Ultrasound-guided injection of the iliopsoas complex is an interventional procedure that uses ultrasound guidance to deliver analgesic and anti-inflammatory medication to the musculotendinous structures that make up the iliopsoas complex: the bursa, tendon, and muscle of the psoas major, and the tendon and muscle of the iliacus muscle.
In routine clinical practice, the target is the psoas tendon and the bursa that protects it from friction with the acetabulum, since these are the structures where most inflammatory or degenerative pathological processes occur.

What are the indications for ultrasound-guided injection of the iliopsoas complex?

The main indications for ultrasound-guided injections of the iliopsoas complex are:

• Acute tendonitis of the psoas tendon: acute pain due to overuse or overexertion that does not resolve with general measures such as rest, NSAIDs, or therapeutic exercise.
• Psoas tendon bursitis: inflammation of the bursa or structure that protects the tendon from excessive friction. It may accumulate more or less fluid, and ultrasound-guided injections of a corticosteroid-based anesthetic provide almost immediate relief.
• Psoas tendon tendinopathy or tendinosis: degenerative wear of the tendon, with multiple causes (aging, overuse, rheumatic diseases, etc.).
• Other hip problems, such as hip osteoarthritis, may coexist with inflammation of the psoas tendon. Ultrasound-guided injections of the hip joint can be combined with ultrasound-guided injections of the psoas tendon and its bursa in the same procedure.

Ultrasound guidance provides a clear and precise view of the psoas tendon and its bursa, while simultaneously monitoring the nerve, arterial, and venous structures in the region. Therefore, ultrasound-guided injections of the iliopsoas complex are an affordable, safe, and precise treatment that can improve pain and function of the affected hip.

What is the procedure for ultrasound-guided injection of the iliopsoas complex?

Ultrasound-guided injection of the iliopsoas complex is performed on an outpatient basis and takes approximately 15 minutes. The procedure is as follows:

• Preparation: The patient is placed supine (face up). The femoral nerve, femoral artery, femoral vein, and psoas tendon are located using ultrasound, and the entry site is marked on the skin.
• Local anesthesia: A small amount of local anesthetic may occasionally be applied to the skin to reduce pain during the injection.
• Asepsis: An antiseptic is applied to the skin, and the equipment and the field are prepared under strict aseptic conditions.
• Ultrasound guidance: Ultrasound is used to guide the needle toward the psoas bursa or the periphery of the tendon, depending on the objective, verifying the diffusion of the medication. We monitor the neurovascular structures at all times.

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