Unexplained Groin Pain in the Elderly: Spontaneous Iliopsoas Tendon Rupture With Haematoma in a 90-Year-Old Woman

Hip and groin pain are frequent presenting complaints among elderly patients. These symptoms are most commonly related to fractures, which are usually identifiable on X-rays. Spontaneous iliopsoas tendon injury, however, is a rare and under-recognised cause of atraumatic hip or groin pain in this population. We report the case of a 90-year-old woman with a history of multiple comorbidities on long-term warfarin for atrial fibrillation who presented with dull left groin pain radiating to the lower back and marked limitation of mobility in the absence of recent trauma. On admission, the international normalised ratio (INR) was 3.98 (reference range, 2-3) and warfarin was held; haemoglobin (Hb) was 87 g/L (reference range, 115-165 g/L), which is the patient's baseline with no fall on serial checks. Examination revealed severe pain on resisted hip movement and groin tenderness, while pelvic X-rays excluded fracture. CT imaging demonstrated bulky soft tissue tracking along the left iliacus muscle extending to the lesser trochanter, consistent with spontaneous iliopsoas tendon rupture with intramuscular haematoma. Orthopaedics recommended conservative management with analgesia, mobilisation as tolerated, and inpatient rehabilitation. MRI was not pursued as it would not have altered the management. The patient remained haemodynamically stable without any drop in haemoglobin levels. This case highlights the importance of considering spontaneous iliopsoas tendon rupture in elderly patients who present with atraumatic hip or groin pain and have non-diagnostic X-rays. Timely cross-sectional imaging is often key to making the diagnosis. Early diagnosis allows appropriate conservative management and is associated with favourable functional outcomes.