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Snapping Hip Syndrome

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Snapping Hip Syndrome

Overview

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.

 

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.

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!

Symptoms

  • 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.

Diagnosis

Snapping hip can be diagnosed by looking at the history and nature of the symptoms, and in rare cases this may need further imaging tests such as ultrasonography, MRI or CT scan. Your Physiotherapist may also 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 may also help them to plan your treatment.

Treatment & 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. Your Physiotherapist may also start you on specific strengthening program once the pain settled to avoid any recurrence.

 

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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