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 6 1 2 3 4 5 6 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 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? Review Topic QID: 2857 1 Limited hip adduction when flexed 13% (279/2081) 2 Limited hip adduction when extended 76% (1585/2081) 3 Limited hip abduction when flexed 4% (73/2081) 4 Limited hip abduction when extended 7% (137/2081) 5 Bow legged gait 0% (0/2081) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (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? Review Topic QID: 1400 1 Coventional MRI 16% (303/1954) 2 CT arthrogram 4% (85/1954) 3 Ultrasound 77% (1514/1954) 4 Weight-bearing radiographs 1% (29/1954) 5 Fluoroscopy without contrast 1% (19/1954) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 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) 11/25/2018 148 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Core Muscle Injury - Michael J. Salata, MD (CSMS #90, 2017) Michael Salata Knee & Sports - Snapping Hip (Coxa Saltans) 11/17/2017 74 views 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) 10/26/2016 588 views See More See Less