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Snapping Hip Syndrome

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Introduction

Snapping hip syndrome, also known as dancer’s hipis a clinical condition characterized by an audible or palpable snapping sensation that is heard during movement of the hip joint. Snapping hip can be caused by multiple factors and is classified based on the anatomic structure that is the cause/source of the snapping sensation. Most of the time, snapping hip syndrome is not painful. However, if you experience pain or swelling around the hip joint that does not go away after a few weeks of rest and activity modification, you should see a Physiotherapist or Doctor to understand what is going on.

Signs & Symptoms

As per current evidence on clinical presentation snapping hip syndrome can be:

  • External
  • Internal

 

External snapping hip occurs when Iliotibial band moving over the Greater Trochanter (the bony prominence that you can feel on outer aspect of your hip) of the femoral head during certain combination of hip movements. It can also be due to proximal hamstring (top end of back of the thigh muscle) rolling over your Ischial Tuberosity (sit bone).

 

Internal snapping hip most commonly occurs as the Iliopsoas tendon (tendon that helps to lift your leg from hip) snaps over underlying bony prominences, such as the Iliopectineal eminence or the anterior aspect of the femoral head. This type of snapping is most commonly experienced at the front of the hip.

 

Common symptoms include:

  • An audible ‘snapping’ in the front, back, or side of the hip when moving the lower limb.
  • Tightness in the hip, usually the front or the back.
  • Swelling in the hip (this is rare).
  • Weakness in the leg mainly around you hip and buttock.
  • Having difficulty in moving the hip for Eg coming to standing from sitting.

Causes

  • Overuse such as sport that involves running / cutting movements and dancing.
  • History of injection to hip muscles eg: gluteus maximus.
  • Surgical procedures – recent total hip replacement.
  • Some anatomical issues such as tendon length, weakness of certain muscle around the hips can also lead into snapping hip.
  • Sometimes there may be no specific causes!

Assessment & Diagnosis

At Pure Physiotherapy, your therapist will take a full history of your condition and will then perform a full physical examination. Your Physiotherapist will ask you to move the hip into different directions to get the hip to ‘snap’ so they can see where and which muscle is affected. This will help your Physio establish a diagnosis, helping them to plan the most appropriate and effective treatment plan for you.

 

In rare cases further imaging tests such as ultrasonography, MRI or CT scan may be required to assist with diagnosis.

Self-Management

When there is no pain, treatment is not warranted but when you have pain your Physiotherapist may advice you to rest, do certain stretching exercises, take anti-inflammatory medications along with activity modification.

Physiotherapy

Your Physiotherapist will be skilled in exercise prescription and will start you on specific strengthening program once the pain settled to avoid any recurrence. They will regularly re-assess you to track your progress and make changes to your exercises so that they continue to challenge your muscles and stimulate adaptation, with the view of reducing symptoms and mitigating any further irritation. You will be given ongoing support and advice so you can manage your symptoms independently.

Escalation of Treatment

Rarely when pain persists despite these conservative measures, surgical intervention can be considered. For external snapping hip syndrome, loosening of the Iliotibial band is usually the goal and can be accomplished with either open or arthroscopic procedures.

 

For internal snapping hip syndrome, open or arthroscopic procedures are available to lengthen or release the Iliopsoas tendon. The most common adverse effect of Iliopsoas release is hip flexor weakness, which may occur if there is excessive release or there is damage to the surrounding area. Corrective surgeries for either internal or external snapping hip can result in other complications including infection, heterotopic ossification, muscle wasting, continued symptoms, weakness of abduction or nerve damage.

References

Nolton, E. C., & Ambegaonkar, J. P. (2018). Recognizing and Managing Snapping Hip Syndrome in Dancers. Med Probl Perform Art33(4), 286-291.

 

Musick, S. R., & Varacallo, M. (2019). Snapping hip syndrome.

 

Potalivo, G., & Bugiantella, W. (2017). Snapping hip syndrome: systematic review of surgical treatment. Hip International27(2), 111-121.

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