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Musculoskeletal and Sports Medicine

Non-Operative Management of Complete Psoas Avulsion After a Fall: A Case Report

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

    Poster Presenter(s)

  • Ryan Triglia, DO

    Resident Physician
    Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
    Levittown, Pennsylvania

    • Co-Author(s)

  • LK

    Leonard B. Kamen, DO

    Clinical Director Jefferson Moss-Magee Outpatient Center
    MossRehab Physical Medicine Associates
    Elkins Park, Pennsylvania

  • Kruti R. Patel

    Medical Student
    Philadelphia College of Osteopathic Medicine
    Philadelphia, Pennsylvania

  • Anand P. Thakkar

    Medical Student
    Philadelphia College of Osteopathic Medicine
    Philadelphia, Pennsylvania

Disclosure(s):
Ryan Triglia, DO: No financial relationships to disclose
Kruti R. Patel: No financial relationships to disclose
Anand P. Thakkar: No financial relationships to disclose
Case Diagnosis: Full-thickness distal avulsion of left iliopsoas tendon

Case Description or Program Description: We present the case of a 64-year-old power wheelchair bound male with medical history of bilateral shoulder dysplasia and cerebellar ataxia with recurrent falls who initially presented to the emergency department with severe left groin pain after a fall during a bathroom transfer. Initial workup including pelvic and hip x-ray was negative for acute pathology and was diagnosed with an adductor muscle strain, ultimately discharged home. The patient proceeded to present to the outpatient rehabilitation office with persisting pain and weakness of his proximal left lower extremity. Physical exam was remarkable for 1/5 left hip flexion strength and painful active and passive hip flexion, as well with internal and external rotation of his left hip. A pelvic and left hip magnetic resonance imaging (MRI) was ordered which demonstrated a full-thickness distal avulsion of the left iliopsoas tendon with tendon retraction and intramuscular hematoma tracking along the iliopsoas muscle.

Setting: Outpatient office

Assessment/Results: The patient was managed non-operatively, with pain control and a formal physical therapy course. He returned after 3 months of physical therapy demonstrating return of full strength to his left hip flexor with near complete pain resolution.

Discussion (relevance): Complete avulsion injuries of the iliopsoas muscle in the older individual are rare, much more frequently associated with the younger athlete. Although typical management is conservative, some cases may require surgical intervention if symptoms should not improve. Strengthening compensatory hip flexor musculature may yield complete return of strength as with our patient.

Conclusions: Iliopsoas avulsion should be considered in the patient who presents with severe groin pain and proximal weakness as great outcomes may be achieved with conservative measures.