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American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/01.phm.0000223222.55943.9a
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Atrophy and Clinical Weakness of the Iliopsoas Muscle: A Manifestation of Hip Osteoarthritis

LaBan, Myron M. MD, MMSc

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From the Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan.

All correspondence and requests for reprints should be addressed to Myron M. LaBan, MD, MMSc, William Beaumont Hospital, Rehabilitation, 3601 West 13 Mile Road, Royal Oak, MI 48073-6769.

Weakness of the iliopsoas muscle secondary to neurogenic compromise of the L2–4 spinal roots has been described as a clinical feature of lumbar spinal stenosis.1 The author of this communication also called attention to the necessity of excluding the presence of osteoarthritis of the ipsilateral hip because degenerative disease of the hip also can be associated with a reduction of strength in the iliopsoas muscle (Fig. 1). However, in this latter situation, the muscular weakness is related to “disuse” atrophy of the iliopsoas muscle (Fig. 2). This muscle normally acts as a primary hip flexor and external rotator of the hip, now limited by the osteoarthritis to a restricted and painful joint range of motion.2 This reduction in iliopsoas strength can readily be demonstrated by placing the supine patient’s symptomatic hip in extreme flexion and comparing its strength to the opposite side by noting its resistance to a downward force exerted just proximal to the patella. In this process, a smooth, uninterrupted, paretic “give” must be distinguished from that of an antalgic, ratchety, or sudden give-away pain-inhibition break. The presence of clinically discernable weakness in the iliopsoas may also compliment the presence of other already well-recognized signs of hip pathology.3 These include Patrick’s or Jansen’s sign, with a demonstrable reduction of hip internal rotation often associated with increasing pain on the involved side.4 At the bedside, a positive Patrick’s sign is a useful clinical aid in distinguishing iliopsoas weakness as a manifestation of lumbar spinal stenosis from that of primary hip pathology, except in those unique instances in which both syndromes are simultaneously present.

Figure 1
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REFERENCES

1. LaBan MM: Iliopsoas weakness, a clinical sign of lumbar spinal stenosis. Am J Phys Med Rehabil 2004;83:224–5

2. LaBan MM, Raptou AD, Johnson EW: Electromyographic study of function of iliopsoas muscle. Arch Phys Med Rehabil 1965;46:676–9

3. Magee DJ: Orthopedic Physical Assessment. Philadelphia, Saunders, 2002, pp 612–37

4. Evans RC: Illustrated Essentials in Orthopedic Physical Assessment. St Louis, CV Mosby, 1994

© 2006 Lippincott Williams & Wilkins, Inc.

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