Overview
Psoas tendinitis involves inflammation of the iliopsoas tendon, often causing lower back, hip, or groin pain. In malignant contexts, it can manifest as malignant psoas syndrome (MPS), characterized by severe pain and fixed hip flexion due to tumor infiltration 135.Diagnosis
Clinical Presentation: Pain in the hip, lower back, or groin, often with limited hip flexion 4.
Imaging: Ultrasound, CT, or MRI can identify abscesses or infiltrative lesions 246.
Pathological Confirmation: Biopsy and next-generation sequencing for infectious causes like Campylobacter fetus 2.
Differential Diagnosis: Includes septic hip arthritis, iliopsoas bursitis, retrocecal appendicitis, and other causes of pelvic pain 4.Management
Antibiotics: For infectious causes, such as Campylobacter fetus, use broad-spectrum antibiotics like meropenem followed by amoxicillin/clavulanate and levofloxacin 2.
Opioids: First-line for pain management, with higher doses often required for lesions in the muscle belly compared to muscle attachments 1.
Neuraxial Analgesia: Consider spinal opioids with local anesthetics for refractory pain in MPS 3.
Percutaneous Catheter Drainage: Effective for abscesses, guided by CT or ultrasound 6.
Adjunctive Treatments: Agents for neuropathic pain, muscle relaxants for spasm, and anti-inflammatory drugs 5.Special Populations
Immunosuppressed Patients: Higher vigilance and aggressive management due to increased risk of severe infections like Campylobacter fetus 2.
Elderly and Comorbidities: Pain management strategies should consider polypharmacy and potential drug interactions 5.Key Recommendations
Use higher opioid doses for lesions in the muscle belly compared to muscle attachments in malignant psoas syndrome (Evidence: Moderate 1).
Consider neuraxial analgesia with local anesthetics for patients with refractory pain due to malignant psoas syndrome (Evidence: Weak 3).
Employ percutaneous catheter drainage guided by imaging for effective management of psoas abscesses (Evidence: Moderate 6).
Aggressively manage infectious causes in immunosuppressed patients to prevent high mortality rates (Evidence: Expert opinion 2).References
1 Ishii K, Komatsu Y, Mori K, Nagaishi E, Matsuo K, Hashizume J et al.. The lesion site in malignant psoas syndrome influences the cancer pain intensity. Annals of palliative medicine 2024. link
2 Luo X, He Y, Zha D, Kang C, Sijie Y. Campylobacter fetus-induced primary psoas abscess in patient with gouty arthritis: A case report and literature review. Medicine 2023. link
3 Yamaguchi T, Katayama K, Matsumoto M, Sato Y, Nakayama N, Hisahara K. Successful Control of Pain from Malignant Psoas Syndrome by Spinal Opioid with Local Anesthetic Agents. Pain practice : the official journal of World Institute of Pain 2018. link
4 Moriarty CM, Baker RJ. A Pain in the Psoas. Sports health 2016. link
5 Agar M, Broadbent A, Chye R. The management of malignant psoas syndrome: case reports and literature review. Journal of pain and symptom management 2004. link
6 Dinç H, Onder C, Turhan AU, Sari A, Aydin A, Yuluğ G et al.. Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses. European journal of radiology 1996. link01045-5)