Evaluation and management of the snapping iliopsoas tendon

Snapping caused by the iliopsoas tendon ("internal coxa saltans") is a common incidental observation that 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 patients can be managed with a properly structured conservative treatment program. However, surgical intervention may be indicated for select recalcitrant painful snapping that is 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, most patients with recalcitrant painful snapping of the iliopsoas tendon have been found to have associated intra-articular pathology. The endoscopic method allows concomitant arthroscopy of the joint to assess and address this coexistent damage that, if overlooked, could be a cause of poor results. A strategy for management of painful snapping caused by the iliopsoas tendon is detailed, including the technique for endoscopic release.