Iliopsoas Tendinitis Medication
- Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Sherwin SW Ho, MD more...
Medication Summary
The drugs of choice for treatment of iliopsoas tendonitis and most other tendinopathies are NSAIDs. This class of drugs provides good analgesia and possible anti-inflammatory properties.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Class Summary
This class of drugs has analgesic and antipyretic activities and possibly also anti-inflammatory activities. Their mechanism of action is not known, but they may inhibit COX activity and prostaglandin synthesis. Other mechanisms may also exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Ibuprin, Advil, Motrin)
DOC for mild to moderate pain. May inhibit inflammatory reactions and pain by decreasing prostaglandin synthesis. Ibuprofen is a low-cost medication.
Naproxen (Anaprox, Naprelan, Naprosyn)
For relief of mild to moderate pain; may inhibit inflammatory reactions and pain by decreasing activity of COX, which is responsible for prostaglandin synthesis. May demonstrate superior analgesic properties compared to ibuprofen.
Cyclooxygenase-2 (COX-2) Inhibitors
Class Summary
Cox-2 inhibitors operate as non-steroidal anti-inflammatory drugs with the potential for less fatal GI bleeding due to ulceration and possibly enhanced analgesic properties. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial.
Celecoxib (Celebrex)
Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient. Provides good analgesia with potential for less GI toxicity.
Analgesics
Class Summary
Useful for patients in whom NSAIDs are contraindicated. Analgesics are potentially useful for patients who require a more prolonged use of analgesics.
Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Contreras ME, Dani WS, Endges WK, De Araujo LC, Berral FJ. Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip: a pilot study. J Bone Joint Surg Br. Jun 2010;92(6):777-80. [Medline].
Ilizaliturri VM Jr, Camacho-Galindo J. Endoscopic treatment of snapping hips, iliotibial band, and iliopsoas tendon. Sports Med Arthrosc. Jun 2010;18(2):120-7. [Medline].
Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med. Jul-Aug 2002;30(4):607-13. [Medline].
Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med. Jun 2004;32(4):998-1001.
Ilizaliturri VM Jr, Chaidez C, Villegas P, Briseno A, Camacho-Galindo J. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. Feb 2009;25(2):159-63. [Medline].
Dobbs MB, Gordon JE, Luhmann SJ, Szymanski DA, Schoenecker PL. Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg Am. Mar 2002;84-A(3):420-4. [Medline].
Byrd JW. Hip arthroscopy. J Am Acad Orthop Surg. Jul 2006;14(7):433-44.
Anderson SA, Keene JS. Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes. Am J Sports Med. Dec 2008;36(12):2363-71. [Medline].
De Paulis F, Cacchio A, Michelini O, Damiani A, Saggini R. Sports injuries in the pelvis and hip: diagnostic imaging. Eur J Radiol. May 1998;27 Suppl 1:S49-59. [Medline].
Fredberg U, Hansen LB. Ultrasound in the diagnosis and treatment of iliopsoas tendinitis: a case report. Scand J Med Sci Sports. Dec 1995;5(6):369-70. [Medline].
Generini S, Matucci-Cerinic M. Iliopsoas bursitis in rheumatoid arthritis. Clin Exp Rheumatol. Sep-Oct 1993;11(5):549-51. [Medline].
Geraci MC. Rehabilitation of the hip, pelvis, and thigh. In: Kibler WB, Herring SA, Press JM, eds. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:226-243.
Jacobs M, Young R. Snapping hip phenomenon among dancers. Am Correct Ther J. May-Jun 1978;32(3):92-8. [Medline].
Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. Sep-Oct 1990;18(5):470-4. [Medline].
Janzen DL, Partridge E, Logan PM, Connell DG, Duncan CP. The snapping hip: clinical and imaging findings in transient subluxation ofthe iliopsoas tendon. Can Assoc Radiol J. Jun 1996;47(3):202-8. [Medline].
Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. Apr 1998;25(4):271-83. [Medline].
Khan K, Cook JL, Maffulli N. Tendinopathy in the active person: Separating fact from fiction to improve clinical management. Am J Med Sports. 2000;2(2):89-99.
Lachiewicz PF, Kauk JR. Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg. Jun 2009;17(6):337-44. [Medline].
Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med. Nov 1988;6(5):295-307. [Medline].
Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med. Mar 1980;14(1):30-6. [Medline].
Shin AY, Morin WD, Gorman JD, Jones SB, Lapinsky AS. The superiority of magnetic resonance imaging in differentiating the causeof hip pain in endurance athletes. Am J Sports Med. Mar-Apr 1996;24(2):168-76. [Medline].
Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomicalbasis of anterior snapping of the hip. Surg Radiol Anat. 2001;23(6):371-4. [Medline].
Taylor GR, Clarke NM. Surgical release of the 'snapping iliopsoas tendon'. J Bone Joint Surg Br. Nov 1995;77(6):881-3. [Medline].
Print
