SNAPPING HIP
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What is a Snapping Hip?
A snapping hip is an audible snapping sound, or the feeling of a snap, which occurs with certain hip movements.
Its believed that abnormal shape of the hip can causes tendons to rub over the bone at the hip joint.
There are 3 types of snapping hip we will discuss: 1) External; 2) Internal; and 3) Intraarticular (within the joint).
The external and internal forms are the most common, and are seen in young athletes (especially in dancers). Its believed that tendons (especially the IT band and the iliopsoas tendon) can become thickened in response to “micro-tears” from intensive sports.
1) The external type occurs on the outside of the hip (lateral) where the IT band rubs over a bony prominence of the hip called the greater trochanter (this type of snapping hip is often accompanied by greater trochanteric bursitis, see talk).
2) The internal snapping hip occurs on the inside of the hip where the iliopsoas tendon rubs over the femoral head or the pelvis (iliopectineal ridge).
3) The intraarticular variant (snapping within the actual hip joint) can occur in all ages, and typically after a specific traumatic injury. A tear in the labrum (a soft tissue lining the hip: similar to the meniscus in the knee) or floating debris within the hip (like a piece of cartilage that chipped off after an injury) leads to a snapping sensation.
Note that many cases have no underlying injury or abnormality to explain the snapping. In fact, some studies suggest that as many of as 10% of the general population has experienced episodes of a snapping hip without any pain or long term symptoms. In such cases, a snapping hip is considered a normal occurrence. The condition is only considered abnormal when it effects daily life, causes pain, or limits a persons activities.
How is a Snapping Hip diagnosed?
People with this condition complain of a snapping sensation, with or without pain. Generally the snapping is worsened by activity, which makes sense because doctors believe it’s a mechanical problem. The snap is usually easily reproducible. If people describe more of a “click” sensation, like a catching or locking feeling of the hip, we start to think the problem is more within the joint (intraarticular).
Examination of hip often follows this saying: “if you can see it, think external snapping hip. If you can hear it, think internal snapping hip”.
X-rays are ordered to rule out any other injuries or injury to the hip, but for this disorder the majority of cases are negative (meaning the x-ray is normal).
If a doctor suspects the intraarticular type, an MRI is often ordered to look for abnormal soft tissue or cartilage floating inside the joint. Sometimes looking inside the hip joint with an arthroscope (this is a type of surgery) is done for diagnostic purposes (however, it can also be a treatment if debris is found and pulled out of the hip joint).
How is a Snapping Hip treated?
Treatment of external and internal snapping hip should proceed in a stepwise fashion, from less invasive to more involved. This condition is mostly treated with activity modification (avoid aggravating activities), anti-inflammatories, and stretching the tight muscles.
Some cases of snapping hip may require surgery if conservative methods described fail to help after 6 months (thats the general minimum time before thinking surgery, you can always try physical therapy and stretching for more than 6 months).
Surgical treatment of External Snapping hip involves the removal of the trochanteric bursa or by lengthening the IT band.
Surgical treatment of Internal snapping hip involves a release (cutting) of the iliopsoas tendon or lengthening of the tendon.
The idea in both cases is to take tension off the aggravating tendon.
The Intraarticular snapping hip usually requires arthroscopic surgery as the initial treatment, to remove the debris.
Reference
Treatment
1) Levine et al. Intramuscular corticosteroid injection for hamstring injuries: a 13-year experience in the National Football League. AJSM 2000; 28: 297-300. full article. steroid injects effectively get players back on field.
2) Gruen GS et al. The surgical treatment of internal snapping hip. AJSM 2002; 30: 607-13. full article. 65% improve with nonop rx. tendon lengthening (9/11) excellent results, would have again, but other study suggest may cause instability in athletes with increased femoral anteversion (fabricant et al).
3) Ilizaliturri VM et al. Prospective randomized study of two different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy 2009; 25: 159-63. full article. lesser troch release vs. transcapsular psoas release equally good outcomes.
4) White RA et al. A new operative approach in the correction of external coxa saltans: The snapping hip. AJSM 2004; 32: 1504-1508. full article. external snapping hip surgical treatment: IT release 14/16 good outcome.