Summary Snapping Hip is a condition characterized by a snapping sensation in the hip that comprises of 3 entities: external snapping hip, internal snapping hip, and intra-articular snapping hip. Diagnosis of external and internal snapping hip is generally made clinically with specific physical examination maneuvers. Advanced imaging is generally required to diagnose intra-articular snapping hip. Treatment can be nonoperative or operative depending on the specific cause of the snapping and duration of symptoms. Epidemiology Demographic common in athletes and dancers in their teens or twenties Etiology Mechanism 3 types of snapping hip exist with different causes external snapping hip login to view 2 more bullets internal snapping hip login to view 5 more bullets intra-articular snapping hip login to view 4 more bullets Presentation Symptoms snapping sensation in and around hip joint may be painful or painless patient often able to reproduce snapping aggravated by activity clicking or locking sensation more indicative of intra-articular pathology Physical exam external snapping hip is often visible while internal snapping is not, but may be audible ("external snapping one can see from across the room, while internal one may hear from across the room") external snapping hip palpate greater trochanter as hip is actively flexed login to view 1 more bullet tightness of tensor fascia lata diagnosed with Ober's Test login to view 1 more bullet internal snapping hip snapping is reproduced by passively moving hip from a flexed and externally rotated position to an extended and internally rotated position Imaging Radiographs recommended views AP pelvis/hip findings usually normal may be useful to rule-out synovial chondromatosis Ultrasound dynamic study which may demonstrate the snapping band in either internal or external snapping may be used to localize a diagnostic challenge injection into the trochanteric bursa (external), the iliopsoas sheath (internal), or intra-articular space. MRI useful to rule-out intra-articular pathology often performed as an arthrogram study may show inflamed bursa Iliopsoas bursography iliopsoas tendon visualized under fluoroscopy after bursa injected with contrast dye may add therapeutic injection after diagnosis is confirmed Treatment Nonoperative often internal and external snapping are painless and require no treatment activity modification indications login to view 1 more bullet physical therapy, injection of corticosteroid indications login to view 1 more bullet Operative excision of greater trochanteric bursa with Z-plasty of iliotibial band indications login to view 2 more bullets release of iliopsoas tendon indications login to view 1 more bullet hip arthroscopy with removal of loose bodies or labral debridement/repair indications login to view 3 more bullets Techniques Excision of greater trochanteric bursa with Z-plasty of iliotibial band technique lengthen the iliotibial band by Z-plasty may be done endoscopically Iliopsoas tendon release approach variety of open approaches have been described login to view 4 more bullets technique tendon is either partially or completely released may be done with the arthroscope login to view 2 more bullets post-operative care avoid hip flexion strengthening for 6 weeks