Snapping Hip Syndrome
What is snapping hip syndrome?
Snapping hip syndrome is characterized by audible snapping of the hip that can be heard by the athlete, and often others. The two most common causes of this syndrome are:
- The iliotibial band that travels from the pelvis to the knee can snap over the greater trochanter (hip), causing irritation of the trochanteric bursa (a bursa that reduces friction between the iliotibial band and the greater trochanter)
- The second major cause is inflammation of the iliopsoas tendon where it attaches to the hip. The iliopsoas tendon may catch over a bony bump (iliopectineal eminence).
Other causes include loose pieces of bone or cartilage within the hip joint or a hamstring tendon (biceps femoris) snapping over the ischial tuberosity (bony bump of the buttocks).
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How does snapping hip syndrome occur?
This condition may occur without any acute injury or may be caused by strain from a sudden increase in amount or intensity of activity. Repetitive motion (hip bending and straightening) may lead to inflammation of the tendon as it passes the bony prominences, leading to thickening and scarring of the tendon and increasing the snapping. It is associated with tight muscles and tendons. Iliotibial band inflammation may also be due to a direct blow to the outer hip.
What increases the risk of snapping hip syndrome?
- Contact or collision sports (football, hockey or soccer)
- Inadequate protection of affected areas during contact or collision sports
- Endurance sports (distance running, triathlon, or race walking) requiring repetitive lower extremity movement
- Activities that require bending, lifting or climbing
- Poor physical conditioning (strength and flexibility)
- Inadequate warm-up before practice or play
- Flat feet
- Valgus lower extremity alignment, in which your knees point toward each other while your feet are straight ahead
- Compensation for other lower extremity injuries
What are the symptoms of snapping hip syndrome?
Hearing the hip snap, often without discomfort, is the major symptom. The location of the snap occurs on the outer part of the hip if the iliotibial band is the cause and in the groin or front of the hip if the iliopsoas tendon is the cause.
How is snapping hip syndrome diagnosed?
History and physical exam are the most important tests to establish snapping hip syndrome. The condition to rule out when considering a snapping hip is a problem within the hip joint, known as “intra-articular.” Such problems include labral tears, injury to the articular cartilage or injury to the ligament within the hip, known as the ligamentum teres. Intra-articular conditions can present with painful snapping, and must be considered in the differential of the snapping hip syndrome.
Are any special tests used to diagnose snapping hip syndrome?
MRI is a very good test to evaluate the intra-articular structures, though it still may miss up to 25 percent of labral tears and is poor at detecting ligamentum teres injuries.
The addition of Gadolinium (contrast dye) into the hip joint enhances detection of labral tears. Even with contrast dye, MRI is a poor test for evaluation of snapping hip syndrome. Snapping hip is a dynamic phenomenon, therefore, a static image such as an X-ray, CT or MRI is unhelpful in confirming the diagnosis.
The best imaging study for snapping hip is to inject contrast dye into the sheath around the suspected involved tendon. The patient actively moves their hip to reproduce the snap under fluoroscopy (live X-ray), which can show the dramatic and sudden movement of the tendon as it snaps over the bony prominence. Ultrasound imaging can also be used in some cases.
How is snapping hip syndrome treated?
Non-operative treatment is indicated for most patients. Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activities that exacerbated the symptoms. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. An orthotic (arch support) may be prescribed for those with flat feet. An injection of cortisone to the area where the tendon inserts into bone may be helpful for iliotibial band inflammation.
Surgery to remove the inflamed tendon lining or degenerated tendon tissue and move the tendon is rarely needed and usually only considered after at least 6 months of conservative treatment. Surgery is usually reserved for the small number of patients with painful snapping that is resistant to non-operative treatment. Historically, open releases were relied upon to decrease tension by surgically incising the relevant tendon responsible for the snapping. Advances in arthroscopic techniques for the hip have led to the ability to not only release the tight tendon arthroscopically with the aid of the small camera, but also to evaluate and treat any associated pathology within the joint.
When can you return to your sport/activity?
This condition is usually curable with time and appropriate treatment. Healing time varies but usually averages two to six weeks.
How can snapping hip syndrome be prevented?
- Wear appropriate protective equipment (hip pads) and ensure correct fit
- Appropriately warm up and stretch before practice or competition
- Allow time for adequate rest and recovery between practices and competition
- Maintain appropriate conditioning:
- Hip, pelvis, and trunk strength
- Flexibility and endurance
- Cardiovascular fitness
- Use proper technique
- Those with flat feet should wear arch supports (orthotics)