Snapping Hip Syndrome

What is Snapping Hip Syndrome?

Snapping hip syndrome, sometimes referred to as dancer’s hip, is a condition where you might notice a snapping sound or feel a snapping sensation when you move your hip. This can happen for a variety of reasons and is often categorized based on what part of the hip is causing the snapping. Historically, there were two main categories: extra-articular (outside the hip joint) and intra-articular (inside the hip joint).

However, the intra-articular category isn’t used as much anymore because we have a better understanding of hip joint conditions now. These can include things like loose bodies (for instance, due to a condition called synovial chondromatosis) or torn labrums (a type of cartilage in the hip).

These days, we tend to break down the extra-articular snapping hip into two sub-categories: external snapping hip and internal snapping hip.

External snapping hip usually happens because certain muscles or tendons are moving over a larger bone or bump (the greater trochanter) on the top end of your thigh bone during hip movements such as bending, straightening, and rotating. Other times, it might be due to the hamstring muscle, fascia lata (a layer of tissue) or a part of the gluteus maximus muscle (one of your buttock muscles) rubbing up against this bump. Another muscle called the psoas could also be rolling over other muscles in the hip. Sometimes, it can be a combination of these factors.

Internal snapping hip, on the other hand, usually happens when a particular tendon (the iliopsoas tendon) snaps over bones that jut out, such as the iliopectinal eminence or the front part of the top end of the thigh bone. Other reasons could include cysts near the labrum or a split iliopsoas tendon. This can feel similar to an intra-articular condition because they both cause sensations at the front of the hip. Doctors can use physical exams and imaging to tell the difference between the two. But, it’s important to note that about half the time, those with an internal snapping hip issue also have some other problem within the hip joint.

What Causes Snapping Hip Syndrome?

Snapping hip is a condition often caused by overusing the hip, but it can also start after something injures the hip, like a shot into the large buttock muscle or surgery. One specific type of snapping hip can happen after hip replacement surgery because the replaced hip has a smaller angle (referred to as coxa vera).

Other shapes or variations of the hip area can also make you more likely to develop this condition. These can include having a greater distance between the major hip bones, larger major hip bones, or a narrower distance across the hips. Furthermore, having a tight band of tissue that goes from the pelvis to the shin (iliotibial band), shorter muscles or tendons, tight muscles, or muscles that don’t relax properly can all affect the development of snapping hip.

Sometimes, doctors can’t find an exact cause for this condition, and they call it idiopathic, meaning the cause is unknown.

Risk Factors and Frequency for Snapping Hip Syndrome

Coxa saltans, commonly known as snapping hip syndrome, affects about 5% to 10% of people. Most people with this condition don’t experience pain, but snapping sounds or sensations can be noticed. It is a bit more common in women than in men. It’s frequently found in people who participate in activities that require a lot of hip movement.

This includes ballet dancers
weight lifters
soccer players
and runners.

It’s notable that nearly 90% of professional ballet dancers report signs of the condition, and 80% of those have it in both hips. Certain ballet moves, especially those which involve rotating the hip outwards or lifting the leg above 90 degrees can trigger the snapping sensation.

Signs and Symptoms of Snapping Hip Syndrome

When a doctor is trying to diagnose the cause of a snapping sensation in the hip, they use your medical history and a physical examination. Usually, the patient can show them precisely where it hurts when their hip snaps. They might even be able to make their hip snap on command. These symptoms usually develop and worsen over a longer period, such as several months or years.

In instances of external snapping hip, the snapping feeling or a ‘false’ sense of dislocation of the hip (also known as pseudosubluxation) is usually more noticeable during the exam. Occasionally, the doctor can actually see or feel the snapping under the patient’s skin. The area around the outer thigh bone might be sore due to inflammation of the fluid-filled sac, any tendon injuries, or inflammation of the fibrous tissue running down the outside of the thigh. To provoke the snap, the doctor usually rotates or bends the patient’s hip. They will test for tightness in this fibrous tissue by having the patient lie on their side and perform a specific test known as the Ober test. While in this same position, the doctor can cycle the patient’s knee and hip through bending and straightening movements to see if the snapping happens.

Internal snapping hip is usually described by the patient as a snapping or locking feeling in the hip, often accompanied by a sound. Sometimes, weakness in the outer hip muscle might be found. To examine this, the patient lies on their back with the problematic hip turned outwards and bent by the doctor. From this position, the leg is straightened into a neutral position next to the resting leg. If the test reproduces the snapping feeling at the front of the hip, it’s considered positive. It’s crucial to remember that about half of the patients with internal snapping hip also have other issues within the joint, which might complicate the findings of the physical examination.

Testing for Snapping Hip Syndrome

If your doctor suspects that your hip issue might be coxa saltans, also known as snapping hip syndrome, they may use several methods to confirm the diagnosis. Primarily, your medical history and physical examination will guide the diagnosis. However, sometimes, additional imaging techniques can be used to check for other potential hip problems and help further confirm the diagnosis.

X-rays, commonly referred to as plain radiographs, may not be very helpful in directly confirming whether you have coxa saltans. That said, they can be useful in ruling out other conditions or potential issues, such as anatomical variations in your hip, developmental dysplasia (improper development of the hip joint), or other hip pathologies (disease conditions).

Another method a doctor might use is anesthetic joint injection. In this process, an anesthetic is injected into the affected area to see the response. If the pain subsides, this can help differentiate between external and internal snapping hip syndrome.

External snapping hip syndrome, which is often visibly notable during physical examination, can also be confirmed by a distinct type of MRI scan known as a T1 weighted axial MRI. This MRI identifies a thickened iliotibial band or thickened anterior edge of the gluteus maximus muscle, which are traits of external snapping hip syndrome.

If this snapping isn’t visible through physical examination, dynamic ultrasonography, a type of real-time ultrasound, can visualise the snapping of the iliotibial band over the greater trochanter, a part of your thigh bone. It can also identify any associated inflammation in tendons (tendonitis), inflammation in the iliopsoas bursal (iliopsoas bursitis), or muscle tears.

For diagnosing internal snapping hip syndrome, a method called iliopsoas bursography combined with fluoroscopy can be used. This method involves injecting a contrast material into the affected area and capturing the images through a fluoroscope. Additionally, dynamic ultrasonography, MRI, or a specific type of MRI known as magnetic resonance arthrography can also confirm the diagnosis. Magnetic resonance arthrography is often preferred because, in addition to confirming the diagnosis, it can also help identify any additional hip joint issues, which are common with internal snapping hip syndrome.

Treatment Options for Snapping Hip Syndrome

When you don’t have pain, treatment is not needed. However, if you feel pain when your hip “snaps”, doctors typically suggest a variety of non-surgical (or conservative) treatments first. These treatments may include rest, stretching exercises, steroid injections, over-the-counter pain relievers, physical therapy, and changes to your lifestyle or physical activity. In many cases, these treatments will help reduce your discomfort.

If your pain continues even after trying these treatments, your doctor might suggest surgery. There are different types of surgeries, depending on whether you have “external” or “internal” snapping hip syndrome.

In external snapping hip syndrome, the goal of surgery is generally to relax or loosen the tight band of connective tissue on the outer side of the thigh known as the iliotibial band. This can be done through traditional open surgery or less invasive procedures known as arthroscopic procedures, which involve small instruments and tiny incisions. The actual procedure could involve creating more slack in the iliotibial band (“lengthening”) or releasing it entirely using several different surgical procedures. Note that a potential risk of these surgeries is that, if too much of the band is released or the surrounding area is damaged, it could lead to weakness in the thigh’s ability to move the leg outwardly (abducting).

For internal snapping hip syndrome, there’s another band called the iliopsoas tendon located in the hip. Once again, surgery aims to lengthen or release this. Just as with external snapping hip syndrome, doctors will often use arthroscopic methods (small tools and small incisions) due to their lower risk of complications compared to open surgery. Here, the most common side effect is the risk of hip flexor weakness. This can happen if too much of the tendon is released or if the surrounding area is harmed.

Finally, it’s important to keep in mind that there are inherent risks with any surgery. In addition to the risks specific to these procedures, these can include infection, abnormal bone growth (heterotopic ossification), muscle shrinkage (atrophy), ongoing symptoms, or nerve damage. Your doctor should discuss these with you thoroughly while considering your treatment options.

When experiencing hip-related issues, various conditions could be causing the discomfort, such as:

Acetabular Labral Tear
Greater Trochanteric or Iliopsoas Bursitis
Femoral Head Avascular Necrosis
Hip Tendonitis
Iliopsoas Tendinitis
Iliotibial Band Syndrome
Intra-Articular Loose Body of the Hip
Synovitis

Frequently asked questions

Most people with snapping hip syndrome do not experience pain, but they may notice snapping sounds or sensations when moving their hip. The condition is more common in women and often affects individuals who participate in activities that require a lot of hip movement, such as ballet dancers, weight lifters, soccer players, and runners. It's important to note that about half the time, those with an internal snapping hip issue also have some other problem within the hip joint.

Snapping Hip Syndrome can be caused by overusing the hip, injury to the hip, such as a shot into the buttock muscle or surgery, or certain variations in the hip area. In some cases, the exact cause is unknown.

Signs and symptoms of Snapping Hip Syndrome include: - Snapping sensation in the hip: Patients may experience a snapping feeling or a 'false' sense of dislocation of the hip. This snapping sensation can be felt or even seen by the doctor during a physical examination. - Pain and soreness: The area around the outer thigh bone may be sore due to inflammation of the fluid-filled sac, tendon injuries, or inflammation of the fibrous tissue running down the outside of the thigh. - Ability to make the hip snap on command: Patients may be able to intentionally make their hip snap during the examination. - Snapping or locking feeling: Internal snapping hip is described by patients as a snapping or locking feeling in the hip, often accompanied by a sound. - Weakness in the outer hip muscle: Patients with internal snapping hip may have weakness in the outer hip muscle. - Positive physical examination tests: Specific tests, such as the Ober test and straightening the leg into a neutral position, can reproduce the snapping feeling at the front of the hip, indicating a positive result. - Long-term development and worsening of symptoms: Symptoms of snapping hip syndrome usually develop and worsen over a longer period, such as several months or years.

The types of tests that may be ordered to properly diagnose Snapping Hip Syndrome include: 1. Medical history and physical examination: These initial assessments can provide important information about the symptoms and physical findings associated with the condition. 2. X-rays (plain radiographs): While not directly confirming the diagnosis of coxa saltans, X-rays can help rule out other hip conditions or anatomical variations. 3. Anesthetic joint injection: This procedure involves injecting an anesthetic into the affected area to determine if the pain subsides, helping to differentiate between external and internal snapping hip syndrome. 4. T1 weighted axial MRI: This specific type of MRI scan can confirm external snapping hip syndrome by identifying a thickened iliotibial band or thickened anterior edge of the gluteus maximus muscle. 5. Dynamic ultrasonography: This real-time ultrasound can visualize the snapping of the iliotibial band over the greater trochanter and identify associated inflammation, tendonitis, bursitis, or muscle tears. 6. Iliopsoas bursography combined with fluoroscopy: This method involves injecting a contrast material into the affected area and capturing images using a fluoroscope to diagnose internal snapping hip syndrome. 7. Magnetic resonance arthrography: This specific type of MRI can confirm internal snapping hip syndrome and also identify any additional hip joint issues. It's important to note that the specific tests ordered may vary depending on the individual case and the doctor's clinical judgment.

The doctor needs to rule out the following conditions when diagnosing Snapping Hip Syndrome: - Acetabular Labral Tear - Greater Trochanteric or Iliopsoas Bursitis - Femoral Head Avascular Necrosis - Hip Tendonitis - Iliopsoas Tendinitis - Iliotibial Band Syndrome - Intra-Articular Loose Body of the Hip - Synovitis

The side effects when treating Snapping Hip Syndrome can include: - Weakness in the thigh's ability to move the leg outwardly (abducting) in the case of surgery for external snapping hip syndrome. - Hip flexor weakness in the case of surgery for internal snapping hip syndrome. - Infection, abnormal bone growth (heterotopic ossification), muscle shrinkage (atrophy), ongoing symptoms, or nerve damage, which are inherent risks with any surgery.

Orthopedic doctor or orthopedic surgeon.

Snapping hip syndrome affects about 5% to 10% of people.

Snapping Hip Syndrome is typically treated with non-surgical (conservative) methods first. These may include rest, stretching exercises, steroid injections, over-the-counter pain relievers, physical therapy, and lifestyle or physical activity changes. If the pain persists after trying these treatments, surgery may be recommended. The type of surgery depends on whether the snapping hip syndrome is external or internal. For external snapping hip syndrome, surgery aims to relax or loosen the tight iliotibial band, while for internal snapping hip syndrome, surgery aims to lengthen or release the iliopsoas tendon. Arthroscopic procedures are often used for both types of surgery due to their lower risk of complications. However, it's important to note that there are inherent risks with any surgery, and these should be thoroughly discussed with a doctor.

Snapping Hip Syndrome is a condition where a snapping sound or sensation is felt when moving the hip. It can be categorized as extra-articular or intra-articular, but the intra-articular category is not used as much anymore.

Joint Muscle and Bone Overuse Injury Trauma