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Snapping Hip Syndrome
From WikiSM
Other Names
- Snapping Hip Syndrome
- Coxa Saltans
- Dancer’s Hip
Background
- This page refers to snapping hip syndrome, a disease with multiple etiologies characterized by an audible or palpable snapping sensation during movement of the Hip Joint
History
- The term was originally coined Nunziata and Blumenfeld to describe the audible snapping sound that occurs around the hip during motion [1]
Epidemiology
- Roughly 5% to 10% of the population is affected by coxa saltans, the majority of patients experiencing painless snapping[2]
- Among ballet dancers, almost 90% reported symptoms of snapping hip syndrome and 80% had bilateral involvement[3]
- More common in women than men
Pathophysiology
- Generally considered to be an overuse syndrome
- May also be precipitated by trauma, surgery
Etiology
- Can be brokwn down into
- Intra-articular
- Extra-articular- medial/ internal
- Extra-articular- lateral/external
- Posterior
Intra-articular
- Loose bodies
- Synovial Chondromatosis
- Osteocartilaginous Exostosis
- Hip Subluxation
- Osteochondral injury
- Acetabular Labrum Tear
- Tear of the Ligamentum Teres
Extra-articular - Internal
- General
- Also referred to as Coxa saltans interna
- Most common overall cause
- Iliopsoas Tendon snapping over Iliopectinal Eminence or anterior aspect of the Femoral Head
- Other less commonly implicated causes:
- Iliofemoral ligament over femoral head, anterior aspect of joint capsule
- Iliopsoas tendon over the anterior inferior iliac spine
- Iliopsoas tendon over the bony ridge on the lesser trochanter
- Tenosynovitis of the iliopsoas tendon
- Iliopsoas bursitis
- Rectus Femoris tendinitis
- Accessory iliopsoas tendon slips
Extra-articular - External
- General
- Sometimes referred to as Coxa saltans externa
- Iliotibial Band snapping over Greater Trochanter
- One of the most common causes
- Movements include flexion, extension, and external or internal rotation
- Other less commonly implicated causes:
- Gluteus Maximus tendon may also snap over the greater trochanter
- Trochanteric Bursitis
- Leg Length Discrepancy
- Coxa vara
- Orthopedic hardware impingement
Posterior
- Tendinous origin of the long head of the Biceps Femoris muscle over the ischial tuberosity
Associated Conditions
Pathoanatomy
- Hip Joint
- Formed by articulation of Femoral Head and Acetabulum
- Socket is deepened by Acetabular Labrum and protected by the joint capsule
- Anterior to joint: Iliopsoas muscle-tendon complex, Iliopsoas Bursa sits between pelvis and muscle belly
- Lateral hip: Greater Trochanter, Gluteal Muscles, and Iliotibial Band
Risk Factors
- Sports that require large large range of hip motions
- Ballet dancers
- Weight lifters
- Soccer players
- Runners[6]
Differential Diagnosis
- Fractures And Dislocations
- Arthropathies
- Muscle and Tendon Injuries
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatric Pathology
- Transient Synovitis of the Hip
- Developmental Dysplasia of the Hip (DDH)
- Legg-Calve-Perthes Disease
- Slipped Capital Femoral Epiphysis (SCFE)
- Avulsion Fractures of the Ilium (Iliac Crest, ASIS, AIIS)
- Ischial Tuberostiy Avulsion Fracture
- Avulsion Fractures of the Trochanters (Greater, Lesser)
- Apophysitis of the Ilium (Iliac Crest, ASIS, AIIS)
Clinical Features
- History
- "External snapping one can see from across the room, while internal one may hear from across the room"[7]
- Patients may have the snapping sensation without any pain
- Patients can often pin point the area of painful snapping
- Ballet dancers may report symptoms worst with external hip rotation, abduction at or over 90°
- Patients often state that there is an audible component to the snapping
- External: May describe a sensation like the hip is going to dislocate or snapping
- Internal: Describes sensation as snapping or “getting stuck” or locking
- Internal: snapping while climbing stairs, getting out of a car, or standing from a chair[8]
- Intra-articular: intermittent clicking, catching, locking, giving way
- Physical Exam: Physical Exam Hip
- Snapping hip, palpation around the entire joint can often isolate the area of interest
- External snapping is commonly more obvious than internal snapping
- External: may be able to visualize or palpate the snapping under the patients skin
- External: May have tenderness over the greater trochanter
- External: Lay in lateral decubitus position, palpate greater trochanter and bring hip into flexion-extension motions
- Internal: Often weakness of gluteus medius is found
- Special Tests
- Ober Test: suggests IT band as etiology
- FADIR Test: suggests intra-articular etiology
- FABER Test: may suggest iliopsoas tendon
- Thomas Test: suggests iliopsoas as etiology
Evaluation
- Snapping hip syndrome is primarily a clinical diagnosis, however imaging is critical in identifying the etiology and planning management
Radiographs
- Standard Radiographs Hip
- Initial imaging modality of choice
- Often normal
- May show
- Cam/ pincer deformity (FAI)
- Small femoral neck angle (coxa vara)
- Developmental dysplasia
- Degenerative joint disease
- Iliopsoas bursography followed by fluroscopy is a somewhat outdated modality
- Can be used to help confirm etiology
MRI
- Useful to evaluate for intra-articular etiology or pathology
- Even more valuable with arthrography is included
- Can show
- Inflammation of the iliopsoas bursa/ muscle
- Inflammation of the trochanteric bursa
- Can demonstrate abnormal soft tissue pathology of the involved tendon, muscle, or bursa
Ultrasound
- General
- Advantage is that it works well dynamically on affected muscle group(s)[9]
- Localize area for diagnostic/ therapeutic injection
- Limited by body habitus, doesnt visualize intra-articular pathology well
- Place transducer over iliopectineal eminence[10]
- During hip flexion, external rotation, and abduction with return to neutral position
- Abnormal iliopsoas tendon snapping against the bony pelvis can be visualized
Computed Tomography
- Best modality for assessing osseous structures of the hip
Classification
- Intra-articular
- Extra-articular - Internal
- Extra-articular - External
- Posterior
Management
Prognosis
Nonoperative
- General
- Nonop treatment is generally considered initial treatment of choice
- Relative rest from offending activities
- Medications
- Short course of NSAIDS, Acetaminophen
- Physical Therapy
- Identify affected muscles groups
- Lengthen/strengthen antagonist/protagonist muscle groups
- Correct posture or abnormal biomechanics
- Important to maintain after resolution of symptoms to prevent recurrence
- Corticosteroid Injection
- External: Can try injection of CSI directly beneath the IT band
- Internal: Can guide needle into iliopsoas bursa, which was shown to be beneficial by Wahl et al[11]
Operative
- Indications
- Refractory to conservative therapy
- Technique depends on etiology
- Internal: Open vs endoscopic lengthening or release of iliopsoas tendon (multiple approaches reported in the literature)
- External: Lengthening of the IT band including Z-plasty
- External: Excision of trochanteric bursa
- External: Release of gluteus maximus tendon
- Arthroscopic approach for loose bodies, labral repair
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Inability to return to sport
- Chronic pain
See Also
- Internal
- External
- Sports Medicine Review Hip Pain: https://www.sportsmedreview.com/by-joint/hip/
References
- ↑ Nunziata A, Blumenfeld I. Snapping hip; note on a variety [article in undetermined language]. Prensa Med Argent 1951;38(32): 1997–2001
- ↑ Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect 2006;55:347–355
- ↑ Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med 2007;35(1):118–126
- ↑ Howse AJ. Orthopaedists and ballet. Clin Orthop Relat Res. 1972; 89:52–63.
- ↑ Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol 2008;190(3):576–581
- ↑ Konczak CR, Ames R. Relief of internal snapping hip syndrome in a marathon runner after chiropractic treatment. J Manipulative Physiol Ther 2005;28(1):e1–e7 Anderson SA, Keene JS. Results
- ↑ https://www.orthobullets.com/knee-and-sports/3096/snapping-hip-coxa-saltans
- ↑ Ilizaliturri VM Jr, Camacho-Galindo J. Endoscopic treatment of snapping hips, iliotibial band, and iliopsoas tendon. Sports Med Arthrosc 2010;18(2):120–127
- ↑ Deslandes M, Guillin R, Cardinal E, et al. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol. Mar; 2008 190(3):576–581.
- ↑ Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol 2008;190(3):576–581
- ↑ Wahl CJ,Warren RF, Adler RS, Hannafin JA, Hansen B. Internal coxa saltans (snapping hip) as a result of overtraining: a report of 3 cases in professional athletes with a review of causes and the role of ultrasound in early diagnosis and management. Am J Sports Med 2004;32(5):1302–1309
Created by:
John Kiel on 5 July 2019 08:50:50
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Last edited:
5 October 2022 13:09:44
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