Principles of diagnostic sonography in iliopsoas tendon pathology: A case report

This article describes the diagnostic value of musculoskeletal sonography in the management of tendon pathology and outlines a clinical example of its scope of utilization. Herein we describe the case of a 65-year-old man who sought rehabilitation services for left groin pain following a period of intense trekking and uphill walking. He presented with left hip flexor weakness and local tenderness over the left iliopsoas tendon with negative findings on neurological evaluation. Additionally, he presented with left hip capsule and hip flexor tightness with left gluteus maximus and gluteus medius weakness. The left hip capsule tightness was predominantly in the posterior fibres, with restriction of hip internal rotation. The clinical picture overall was suggestive of the presence of risk parameters for iliopsoas tendinopathy. Plain radiographs of the hip revealed mild degenerative changes with a mild pincer impingement. While his clinical and radiological picture was suggestive of degenerative and soft tissue pathology of the hip, a real-time sonographic study was useful in the quantitative confirmation of a partial tear of the left iliopsoas tendon. Additionally, a repeat sonographic study performed four weeks later, revealed a healing iliopsoas tendon seen as a decrease in the width of the hypoechoic presentation of the tear. To summarize, the value of musculoskeletal sonography as a diagnostic tool as well as the assessment of the progression of tendon healing is discussed. Sonography is safe, noninvasive, and does not use ionizing radiation. It is steadily gaining popularity in the diagnosis of tendon lesions.