Snapping hip or “coxa saltans” is a condition in a which a patient may hear a snapping sound or feel a snapping sensation inside or around the hip.
This snapping may occur when you walk, run, get up from a chair, or swing your leg around. You may be able to reproducibly snap your hip with certain movements. Snapping hip symptoms may include pain and weakness that interfere with performance.
What causes snapping hip?
In most cases, snapping is caused by the movement of a muscle or tendon over a bony structure in the hip.
The most common site of snapping is on the outside of the hip (External Snapping Hip or “coxa saltans externa”) where a band of connective tissue known as the iliotibial band passes over part of the femur (thigh bone) that juts out into a prominence called the greater trochanter. When you stand up straight, the band lies behind the greater trochanter. When you flex (bend) your hip, the band moves over and in front of the greater trochanter. If this band is too tight it may forcibly flick or snap over.
What is the treatment for snapping hip?
Firstly, snapping hip is common. Snapping that does not cause symptoms does not require treatment. Symptomatic (painful or bothersome) external snapping hip can often be successfully treated with non-operative measures which include stretching, physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections.
Surgical intervention for external snapping hip syndrome may be indicated when nonsurgical management is not successful.
Both open and arthroscopic (keyhole) surgical techniques have been successfully used to lengthen the IT band to stop it from snapping and also to manage any associated trochanteric bursitis. Mr Freedman usually prefers a keyhole approach as this provides quicker recovery. Keyhole surgery also avoids a large scar over the greater trochanter which can itself be a source of discomfort.
Internal snapping hip or “Coxa saltans interna” occurs when a tendon which runs in front of the hip (the iliopsoas tendon) catches on the pelvis or or on the ball of the femur. Patients with symptomatic internal snapping hip syndrome often present with anterior groin pain and audible snapping. Dynamic ultrasonography can be used to visualize the abnormal motion of the iliopsoas tendon. Recurrent snapping of the psoas tendon may cause impingement on the labrum and potentially lead to labral tears. Conservative treatment measures consist of rest, stretching, and non-steroidal medication (NSAIDs). Corticosteroid injections under either fluoroscopic or ultrasound guidance can be beneficial for the diagnosis and management of iliopsoas tendinitis.
Surgical intervention is reserved for cases that do not respond to nonsurgical measures. Open surgical options have been described, with generally favorable results, although complications including sensory deficits over the front of the hip and recurrence have been reported. Mr Freedman prefers a keyhole technique as this is much less invasive, has quicker recovery and generally lower risk of complications.
The third variant or intra-articular snapping hip is the result of labral tears, loose bodies, or cartilage flaps within the hip joint. These can also be addresses through keyhole surgery.