[Iliopsoas muscle syndrome. Functional disorders: shortening, spasm and weakness of a structurally unchanged muscle]

Functional (non-organic) disorders of the iliopsoas muscle (IPM), i.e. the shortening, spasm and weakness of the structurally unchanged IPM, can be manifested as abdominal and/or pelvic pain, pain in areas of the thoracolumbar (ThL) and lumbosacral (LS) spine, sacroiliac (SI) joint, hip, groin and anterior thigh on the side of the affected muscle as well as gait disturbances (iliopsoas muscle syndrome). By clinical examination of the IPM, including the transabdominal palpation, stretch and strength tests, pathological masses, shortening, painful spasm, weakness and tendon tenderness of that muscle can be diagnosed. The IPM is, like other postural muscles, inclined to shortening. The weakness of the IPM can be a consequence of the lesion of the lumbar plexus or femoral nerve that innervate the IPM, as well as a consequence of certain organic diseases of the IPM. Painful stimuli coming from somatic and visceral structures that are innervated from Th12-L4 nerve roots, from which the IPM segmental innervation also originates, can cause a reflex spasm of the IPM. A painful spasm of the IPM caused by disorders of the ThL and LS spine, SI and hip joint, can mimic diseases of the abdominal and pelvic organs. In the differential diagnosis of the IPM painful spasm, organic diseases of that muscle should be considered foremost (abscess, hematoma, tumor, metastase), as they can result in spasm, and the diseases of the abdominal and pelvic organs that can cause an IPM reflex spasm. The IPM functional disorders, which are not rare, are often overlooked during a clinical examination of a patient. Reasons for overlooking these disorders are: 1) a nonspecific and variable clinical picture presenting the IPM functional disorders, 2) the IPM functional disorders are a neglected source of pain, 3) the inaccessibility of the IPM for inspection, 4) the lack of knowledge of the IPM examination techniques and 5) the IPM functional disorders cannot be discovered by radiological examinations of the abdomen. From a therapeutic point of view, it is important to recognise the IPM functional disorders since these disorders respond very well to appropriate therapy. Etiopathogenesis, clinical picture, diagnosis, differential diagnosis and therapy of the IPM functional disorders are described in the article.