Iliopsoas abscess (IPA)
S&S
· Fever · Back pain · Anterior thigh or groin pain · Gastrointestinal or Genitourinary symptoms · Pain is sharp and radiating · Pain with sitting upright · Tenderness to palpation · Psoas spasm · Possible weight loss and nausea |
Rule in or Rule out
• Tenderness of the iliopsoas muscle • Limp, palpable mass in the inguinal region • Severe pain upon passive hyperextension of the hip or active flexion of the psoas against the examiner’s hand can be specific for psoas abscess • Reproduction of pain or symptoms with administration of special test • Presence of associated signs and symptoms • Injury or infection within the area • Immunocompromised system-AIDS and TB have high correlations with IPA Non-Physical Therapeutic Methods • CT/ Ultrasound/ MRI · Ultrasound guided percutaneous drainage followed by Antibiotics · If infection is suspected laboratory test may be ordered, otherwise they are non-specific for this diagnosis |
Background
The psoas muscle is located behind the peritoneum and originates from the lateral borders of the 12th thoracic to the 5th lumbar vertebrae. The psoas muscle inserts as a tendon into the lesser trochanter of the hip. A psoas abscess is described as “psoitis”, which is a a collection of pus in the psoas compartment. This is a rare condition consisting of pyomyositis of the psoas and can be primary or secondary. A primary abscess is an infection of the psoas muscle, and a secondary abscess results from the direct extension of an infection from adjacent organs or structures. A psoas abscess is capable of running along the psoas sheath to the inner upper third of the thigh. However, rarely does the abscess penetrate the sheath and involve the adductor muscles. Diagnosis of the psoas abscess is a challenging due to its insidious clinical presentation. Diagnosis should be made early on to increase prognostic outcomes.
The psoas muscle is located behind the peritoneum and originates from the lateral borders of the 12th thoracic to the 5th lumbar vertebrae. The psoas muscle inserts as a tendon into the lesser trochanter of the hip. A psoas abscess is described as “psoitis”, which is a a collection of pus in the psoas compartment. This is a rare condition consisting of pyomyositis of the psoas and can be primary or secondary. A primary abscess is an infection of the psoas muscle, and a secondary abscess results from the direct extension of an infection from adjacent organs or structures. A psoas abscess is capable of running along the psoas sheath to the inner upper third of the thigh. However, rarely does the abscess penetrate the sheath and involve the adductor muscles. Diagnosis of the psoas abscess is a challenging due to its insidious clinical presentation. Diagnosis should be made early on to increase prognostic outcomes.
Referral patterns
• Pain in the abdominal region due to muscle tightness or trigger points • Pain in the lower back due to muscle tightness of trigger points • Pain referred into the adductors |
Special Tests
• Palpate iliopsoas muscle • Iliopsoas muscle test Sensitivity: 16% Specificity: 95% • Obturator muscle test • Heel Tap • Hop Test |
For more information on special testing for psoas abscess please follow the video link bellow
Specific comments (red flags/ yellow flags)
Iliopsoas abscess from gastrointestinal origins is most frequently associated with inflammatory bowel disease . Presence of this abscess may also be related to Crohn disease abscesses secondarily involving the iliopsoas muscles.
Iliopsoas abscess from gastrointestinal origins is most frequently associated with inflammatory bowel disease . Presence of this abscess may also be related to Crohn disease abscesses secondarily involving the iliopsoas muscles.
References:
Dietrich, MD, A., Vaccarezza, MD, H., & Vaccaro, MD, PhD, C. A. (2013, February). Iliopsoas Abscess: Presentation, Management, and Outcomes. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 23(1), 45-48. Retrieved July 1, 2013
Fernández, J., López, P., Montes, J., & Cara, M. (2009). Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department. Revista Espanola De Enfermedades Digestivas, 101(9), 610-618. Retrieved June 25, 2013, from PubMed.
Tabrizian, MD, P., Nguyen, MD, S. Q., Greenstein, MD, MPH, A., Rajhbeharrysingh, MD, U., & Divino, MD, C. M. (2009, October). Management and Treatment of Iliopsoas Abscess. ARCH SURG, 144(10), 946-949. Retrieved July 1, 2013, from PubMed.
Tomich, DO, E. B., & Della-Giustina, MD, D. (2009, November). Bilateral Psoas Abscess in the Emergency Department. Western Journal of Emergency Medicine, X(4), 288-291. Retrieved July 1, 2013, from PubMed.
Zhou, Z., Song, Y., Cai, Q., & Zeng, J. (2010, August 6). Primary psoas abscess extending to thigh adductors: case report. BMC Biomedical Central Musculoskeletal Disorders, 11(176), 1-4. Retrieved July 1, 2013, from PubMed.
Images provided by: http://www.doctorschierling.com/hip-flexor-tendinosis.html
http://www.studyblue.com/notes/note/n/clinical-correlations-of-the-lower-limb/deck/1659489