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Musculoskeletal and Sports Medicine

Giant Iliopsoas Bursitis and Concomitant Hip Osteoarthritis: a Case Report of Anterior Hip Pain Requiring Multimodal Management

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Poster Presenter(s)

  • Samuel Olson, MD

    Medical Resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Santa Monica, California

    • Co-Author(s)

  • Maggie Weichert, Other

    Medical Student
    Renaissance School of Medicine At Stony Brook University
    Stony Brook, New York

  • RO

    Resa Oshiro, MD

    Acting Chief of Pm&R
    Veterans Health Administration
    Los Angeles, California

Disclosure(s):
Samuel Olson, MD: No financial relationships to disclose
Maggie Weichert, Other: No financial relationships to disclose
Case Diagnosis: A 51 year-old male with sudden-onset right anterior hip pain, found to have right sided giant Iliopsoas bursitis and hip OA on MRI, who required multimodal management following a partial reduction in pain after CSI to the Iliopsoas bursa.

Case Description or Program Description: A 51-year-old male presented with sudden-onset right groin pain starting two months prior to evaluation. The pain was exacerbated by hip flexion, walking, and minimally relieved with NSAIDs and physical therapy. Physical examination revealed an antalgic gait, and reproduction of concordant groin pain with resisted hip flexion. MRI was ordered and revealed a large multiloculated fluid collection (8 x 6 cm) consistent with giant iliopsoas bursitis with mild-to-moderate hip osteoarthritis.

Setting: Outpatient MSK

Assessment/Results: The patient underwent an ultrasound-guided CSI into the iliopsoas bursa, leading to partial symptom relief (VAS 9/10 → 6/10). Given the incomplete pain response and MRI suggestive of concurrent hip OA, a second CSI into the hip joint was planned for diagnostic and therapeutic purposes.

Discussion (relevance): Iliopsoas bursitis is an uncommon cause of anterior hip pain with an estimated prevalence of 2.2% in patients with symptomatic hip osteoarthritis. Due to its rarity, information regarding etiology, diagnosis, and treatment of iliopsoas bursitis is largely based on case reports. Previously described causes include trauma, overuse, and inflammatory arthropathies. Initial treatment consists of physical therapy, activity modification, and NSAIDs.
Corticosteroid injections (CSI) to the bursa can be helpful for symptomatic relief. Partial responses, such as in this case, may necessitate additional targeted interventions.

Conclusions: In cases of groin pain that is severe, sudden in onset, and exacerbated primarily by hip flexion MRI can identify iliopsoas bursitis in addition to coexisting hip joint pathology. Persistent symptoms following CSI to the iliopsoas bursa implies alternative pain generators, and
multimodal treatment approaches should be considered in cases of refractory groin pain and giant iliopsoas bursitis.