Iliopsoas muscle

Westhoff B, Seller K, Wild A, et al. Ultrasound-guided botulinum toxin injection technique for the iliopsoas muscle. Dev Med Child Neurol. 2003 45 829-832. 

The iliopsoas muscle also plays an important role in the synergistic activities of the muscles of the low back in maintaining a normal lumbosacral angle and proper postural balance. 

The iliopsoas muscle is often considered the "mainstay" in the column support system. It therefore has the potential for a significant role in the back pain of pregnancy and in back pain... 

The iliopsoas bursa is a large synovial-lined bursa which lies between the posterior aspect of the iliopsoas muscle and tendon and the anterior capsule of the hip joint. It measures approximately 5-7 cm in length and 2-4 cm in width and communicates with the hip joint in 10-15% of cases through a foramen 1-2 mm to 3 cm wide located between the pubofemoral and iliofemoral ligaments. In normal states, the... 

The anterior muscles detected at the articular level are, from lateral to medial the tensor fasciae latae, the rectus femoris, the sartorius, the iliopsoas and the pectineus. Over the joint space, the iliopsoas muscle is the first to be identified in a lateral position relative to the femoral neurovascular bundle. Its tendon lies in an eccentric position within the posterior part of the muscle belly and can be detected as a hyperechoic anisotropic fibrillar structure (Fig. 12.14). The tendon is in close relationship with the anterior hip capsule and the two structures can usually be distinguished... 

Fig. 12.14a,b. Iliopsoas muscle and tendon, a Transverse and b sagittal 12-5 MHz US images obtained over the anterior aspect of the hip joint in a healthy subject demonstrate the iliopsoas muscle (IPs) and tendon (arrow), which are located between the rectus femoris (RF) and the neurovascular bundle, superficial to the anterior capsular plane (white arrowhead) and the articular cartilage (rhombi) of the femoral head (FH). FN, femoral nerve FA, common femoral artery Ac, acetabulum. The photograph and the schematic drawing at the left side of the figure indicate probe positioning... 

Fig. 12.17. Intrapelvic portion of the iliopsoas muscle. Transverse 12-5 MHz US image obtained over the intrapelvic portion of the iliopsoas (IPs) muscle in a healthy subject. The muscle is seen lying over the anterior surface of the iliac bone. Its tendon (arrow) is located in an anterior and medial position. It appears as a well-defined oval hyperechoic structure embedded within the hypoechoic muscle belly. The femoral nerve (FN) is found in a superficial location, just laterally to the common femoral artery (FA). FV, femoral vein. The photograph and the schematic drawing at the left side of the figure indicate probe positioning...

Medially to the iliopsoas muscle and tendon, US is able to image the femoral neurovascular bundle... 

Fig. 12.62. Total hip replacement. Longitudinal oblique 12-5 MHz US image obtained over the anterior aspect of the hip joint in a patient with a hip prosthesis. The prosthetic components are well depicted with US, including the acetabular part (Ac), the head (H) and the neck (N). Posterior reverberation artifacts are manifest (arrowheads). A discrete amount of fluid (asterisk) distends the anterior recess of the pseudocapsule. IPs, iliopsoas muscle...

Fig. 12.65a-f. Acetabular cup for hip replacement, a Photograph, b standard radiograph and c in vitro US appearance of an acetabular spiral screwed cup. US depicts the cup as a hyperechoic structure with reverberation artifact characterized by a series of external teeth arrowhead), d-f Schematic drawings of a sagittal view through the anterior hip illustrate d a normally positioned cup, e,f an anterior protruding cup resulting in e iliopsoas bursitis asterisks) and f tears of the undersurface of the iliopsoas muscle arrowheads). A, native acetabulum Ac, acetabular cup H, head of the prosthesis N, neck of the prosthesis F, femoral bone... 

Fig. 12.66a,b. Acetabular cup anteversion. a Arcelin X-ray view of the right hip in a patient who underwent total hip replacement. Note the anterior rotation and protrusion of the anterior edge arrowhead) of the cup. b Longitudinal 12-5 MHz US image demonstrates the impingement of the protruding cup (arrow) with the iliopsoas tendon arrowhead). In this particular case, there was no tendon lesion. IPs, iliopsoas muscle... 

Fig. 12.68a,b. Iliopsoas impingement by an acetabular cup. a Transverse oblique 12-5 MHz US image obtained over the anterior hip shows a beak-shaped hyperechoic projection (arrowheads) on the anterior border of the acetabular cup surrounded by an effusion (asterisks). Ac, acetabulum. IPs, iliopsoas muscle, b Correlative transverse CT image demonstrates a hyperdense anterior structure (arrowhead) which impinges on the posterior aspect of the iliopsoas muscle (IPs), representing cement leakage following the hip replacement procedure... 

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