Anders Alpha, Vitale Kenneth
Louisiana State University School of Medicine, New Orleans, Lousiana, United States.
Department of Orthopaedic Surgery, University of California School of Medicine, La Jolla, California, United States.
J Rehabil Med Clin Commun. 2022 Aug 18;5:2541. doi: 10.2340/jrmcc.v5.2541. eCollection 2022.
Hip pain is common in patients of advanced age and has a very broad differential. Of the potential aetiologies, iliopsoas tendon ruptures are rare. Consequently, there is a paucity of literature on iliopsoas rupture in the older adult population, and its rarity can lead to a delay in its diagnosis. When iliopsoas ruptures do occur, they are typically secondary to trauma; however, they can occur spontaneously. Iliopsoas injuries can be disabling, but they respond well to conservative management. We report here a case of a 70-year-old woman who presented to an unaffiliated emergency department with left anterior hip pain 2 weeks after a fall from standing height.
Initial X-ray and computed tomography were negative for fracture, and the patient was discharged with home health physical therapy. Her symptoms persisted. At a subsequent emergency department visit several weeks later, magnetic resonance imaging revealed a complete left iliopsoas tendon rupture with retraction. She was treated conservatively and made a complete recovery after physical therapy.
This paper reviews the literature related to iliopsoas injuries, highlights the importance of iliopsoas tendon injuries among the differential for acute hip pain, and provides management recommendations for this rare, but probably underdiagnosed, injury. This treatable condition warrants further attention, as delay in diagnosis can prolong morbidity.
髋部疼痛在老年患者中很常见，鉴别诊断范围非常广泛。在潜在病因中，髂腰肌肌腱断裂很少见。因此，关于老年人群中髂腰肌断裂的文献很少，其罕见性可能导致诊断延迟。当髂腰肌断裂确实发生时，通常继发于创伤；然而，也可能自发发生。髂腰肌损伤可能导致功能障碍，但对保守治疗反应良好。我们在此报告一例70岁女性病例，她从站立高度跌倒2周后因左髋前部疼痛就诊于一家非附属急诊科。
最初的X线和计算机断层扫描未发现骨折，患者出院并接受家庭健康物理治疗。她的症状持续存在。几周后再次到急诊科就诊时，磁共振成像显示左侧髂腰肌肌腱完全断裂并回缩。她接受了保守治疗，物理治疗后完全康复。
本文回顾了与髂腰肌损伤相关的文献，强调了髂腰肌肌腱损伤在急性髋部疼痛鉴别诊断中的重要性，并为这种罕见但可能诊断不足的损伤提供了管理建议。这种可治疗的疾病值得进一步关注，因为诊断延迟会延长发病时间。
