Evaluation and Management of the Snapping Iliopsoas Tendon

Summary: Snapping caused by the iliopsoas tendon (“internal coax saltans”) is a common incidental observation. This often requires little treatment on the part of the clinician other than assurance to the patient that this finding is not a harbinger of future problems. Most symptomatic cases can be managed with a properly structured conservative program. However, surgical intervention may be indicated for select recalcitrant cases unresponsive to conservative treatment. Traditional literature has proposed open procedures with relaxation or release of the tendinous portion of the iliopsoas. Recent experience with endoscopic release of the iliopsoas has met with favorable results at least comparable to those reported for open techniques. An obvious advantage is the less invasive nature that facilitates rehabilitation and return to function. However, of equal importance, the majority of patients with recalcitrant painful snapping of the iliopsoas tendon have been found to have associated intraarticular pathology. The endoscopic method allows concomitant arthroscopy of the joint to assess and address this coexistent damage which, if overlooked, could be a cause of poor results. A strategy for management of painful snapping resulting from the iliopsoas tendon is detailed, including the technique for endoscopic release.