Introduction A condition characterized by a snapping sensation in the hip caused by motion of muscles and tendons over bony structures around the hip joint Epidemiology common in athletes and dancers in their teens or twenties 3 types of snapping hip exist with different causes external snapping hip caused by iliotibial tract sliding over greater trochanter internal snapping hip most common form caused by iliopsoas tendon sliding over femoral head prominent iliopectineal ridge exostoses of lesser trochanter iliopsoas bursa intra-articular snapping hip caused by loose bodies in the hip may be seen with synovial chondromatosis labral tears 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 applying pressure will likely stop snapping, confirming diagnosis tightness of tensor fascia lata diagnosed with Ober's Test limited hip adduction when hip held in extension 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 acute onset (<6 months) of painful internal or external snapping hip physical therapy, injection of corticosteroid indications persistent, painful snapping interfering with activities of daily living Operative excision of greater trochanteric bursa with Z-plasty of iliotibial band indications painful external snapping hip that has failed nonoperative management snapping after total hip replacement release of iliopsoas tendon indications painful internal snapping hip that has failed of nonoperative management hip arthroscopy with removal of loose bodies or labral debridement/repair indications intra-articular snapping hip that has failed nonoperative management and has MRI confirmation of loose bodies labral tear Surgical 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 anterior medial ilioinguinal iliofemoral technique tendon is either partially or completely released may be done with the arthroscope trans-capsular from the central compartment endoscopically off of the lesser trochanter) post-operative care avoid hip flexion strengthening for 6 weeks
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.44) A positive Ober test for contracture of the tensor fascia lata and iliotibial band is characterized by which of the following? Tested Concept QID: 2857 Type & Select Correct Answer 1 Limited hip adduction when flexed 13% (440/3515) 2 Limited hip adduction when extended 77% (2708/3515) 3 Limited hip abduction when flexed 3% (114/3515) 4 Limited hip abduction when extended 7% (237/3515) 5 Bow legged gait 0% (2/3515) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.61) A 20-year-old man reports painless snapping about the lateral aspect of the right hip. He denies any history of trauma. Examination reveals no limp or tenderness. Hip range of motion is full, and there is good strength. Radiographs are normal. What anatomic structure is most likely causing these symptoms? Tested Concept QID: 8723 Type & Select Correct Answer 1 Acetabular labrum 2% (11/480) 2 Iliopsoas 12% (58/480) 3 Loose body 1% (3/480) 4 Piriformis 1% (3/480) 5 Iliotibial band 84% (402/480) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.15) A 21-year-old professional ballet dancer reports a painful popping sensation over her right hip joint. Examination reveals that symptoms are reproduced with hip flexion and external rotation. Which of the following studies will best confirm the diagnosis? Tested Concept QID: 8677 Type & Select Correct Answer 1 Radiographs 1% (4/413) 2 Bone scan 0% (0/413) 3 CT 0% (2/413) 4 Ultrasonography 57% (234/413) 5 MRI 42% (172/413) L 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (SBQ07SM.15) A 16 year-old dancer has developed popping over the anterior hip. On exam, this can be reproduced by starting with the hip flexed, abducted and external rotated, and then slowly extending it back to a neutral position. She has no pain with internal rotation of the flexed hip. There is no tenderness or popping laterally. The diagnosis can be confirmed using which imaging modality? Tested Concept QID: 1400 Type & Select Correct Answer 1 Coventional MRI 17% (452/2723) 2 CT arthrogram 5% (132/2723) 3 Ultrasound 75% (2049/2723) 4 Weight-bearing radiographs 2% (51/2723) 5 Fluoroscopy without contrast 1% (30/2723) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept
All Videos (6) Podcasts (3) Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Rehab for Extra-Articular Hip Pathology - Melissa Strzelinski, PT, MPT (CSMS #102, 2018) Knee & Sports - Snapping Hip (Coxa Saltans) C 11/25/2018 279 views 3.0 (1) Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Case Presentations, Question and Answer - Richard C. Mather III, MD (CSMS #90, 2016) Richard Mather Knee & Sports - Snapping Hip (Coxa Saltans) A 10/26/2016 624 views 4.5 (2) Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Rehab for Extra-Articular Hip Pathology - Caty Stegemann, PT (CSMS #89, 2016) Knee & Sports - Snapping Hip (Coxa Saltans) C 10/26/2016 378 views 3.3 (3) Question Session⎪Snapping Hip (Coxa Saltans) Orthobullets Team Knee & Sports - Snapping Hip (Coxa Saltans) Listen Now 14:22 min 11/6/2019 51 plays 0.0 (0) Knee & Sports⎜ Snapping Hip (Coxa Saltans) Team Orthobullets 4 Knee & Sports - Snapping Hip (Coxa Saltans) Listen Now 7:23 min 10/21/2019 54 plays 0.0 (0) Sports⎪Snapping Hip (Coxa Saltans) Team Orthobullets 4 Knee & Sports - Snapping Hip (Coxa Saltans) Listen Now 7:11 min 10/15/2019 186 plays 5.0 (1) See More See Less