Snapping hip syndrome

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Snapping hip syndrome
Other namesCoxa saltans, iliopsoas tendinitis, dancer's hip
Anterior Hip Muscles 2.PNG
Anterior hip muscles
Specialty Rheumatology   OOjs UI icon edit-ltr-progressive.svg

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra- articular or intra-articular. [1]

Contents

Symptoms

In some cases, an audible snapping or popping noise as the tendon at the hip flexor crease moves from flexion (knee toward waist) to extension (knee down and hip joint straightened). It can be painless. [2] After extended exercise, pain or discomfort may be present caused by inflammation of the iliopsoas bursae. [3] Pain often decreases with rest and diminished activity. Symptoms usually last months or years without treatment and can be very painful.[ citation needed ]

Extra-articular

The more common lateral extra-articular type of snapping hip syndrome occurs when the iliotibial band, tensor fasciae latae, or gluteus medius tendon slides back and forth across the greater trochanter. This normal action becomes a snapping hip syndrome when one of these connective tissue bands thickens and catches with motion. The underlying bursa may also become inflamed, causing a painful external snapping hip syndrome.[ citation needed ]

Less commonly, the iliopsoas tendon catches on the anterior inferior iliac spine, the lesser trochanter, or the iliopectineal ridge during hip extension, as the tendon moves from an anterior lateral (front, side) to a posterior medial (back, middle) position. With overuse, the resultant friction may eventually cause painful symptoms, resulting in muscle trauma, bursitis, or inflammation in the area.[ citation needed ]

Intra-articular

Because the iliopsoas or hip flexor crosses directly over the anterior superior labrum of the hip, an intra-articular hip derangement (i.e. labral tears, hip impingement, loose bodies) can lead to an effusion that subsequently produces internal snapping hip symptoms.[ citation needed ]

Causes

The causes of snapping hip syndrome are not fully understood. The onset is often insidious with reports of a "non-painful" sensation or audible snapping, clicking, or popping with certain activities. Individuals often ignore the "snapping" sensation, which may lead to future discomfort with activity. [2] Athletes appear to have an increased risk of snapping hip syndrome due to repetitive and physically demanding movements. Among athletes such as ballet dancers, gymnasts, horse riders, track and field athletes and soccer players, military training, or any vigorous exerciser, [4] repeated hip flexion can lead to injury. In excessive weightlifting or running, the cause is usually attributed to extreme thickening of the tendons in the hip region. [5] Snapping hip syndrome most often occurs in people who are 15 to 40 years old.[ citation needed ]

Extra-articular

Extra-articular snapping hip syndrome is commonly associated with leg length difference (usually the long side is symptomatic), tightness in the iliotibial band (ITB) on the involved side, weakness in hip abductors and external rotators, poor lumbopelvic stability and abnormal foot mechanics (overpronation). [6] Popping during external snapping hip (lateral-extra articular), occurs when the thickened posterior aspect of the ITB or the anterior gluteus maximus rubs over the greater trochanter as the hip is extended. Internal snapping hip (medial-extra articular) is usually described by the patient as a snapping or locking of the hip with an audible snap and occurs when the iliopsoas tendon snaps over underlying bony prominences. [7] Almost half of patients with internal snapping hip also have inter-articular pathology. [7]

Intra-articular

The causes of intra-articular snapping hip syndrome seem to be broadly similar to those of the extra-articular type, but often include an underlying mechanical problem in the lower extremity. The pain associated with the internal variety tends to be more intense and therefore more debilitating than with the external variety. [4] Intra-articular snapping hip syndrome is often indicative of injury such as a torn acetabular labrum, ligamentum teres tears, loose bodies, articular cartilage damage, or synovial chondromatosis (cartilage formations in the synovial membrane of the joint).[ citation needed ]

Diagnostic

Treatment

This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern. Correcting any contributing biomechanical abnormalities and stretching tightened muscles, such as the iliopsoas muscle or iliotibial band, is the goal of treatment to prevent recurrence.[ citation needed ]

Referral to an appropriate professional for an accurate diagnosis is necessary if self treatment is not successful or the injury is interfering with normal activities. Medical treatment of the condition requires determination of the underlying pathology and tailoring therapy to the cause. The examiner may check muscle-tendon length and strength, perform joint mobility testing, and palpate the affected hip over the greater trochanter for lateral symptoms during an activity such as walking.[ citation needed ]

Self-treatment

A self-treatment recommended by the U.S. Army for a soft tissue injury of the iliopsoas muscle treatment, like for other soft tissue injuries, is a HI-RICE (Hydration, Ibuprofen, Rest, Ice, Compression, Elevation) regimen lasting for at least 48 to 72 hours after the onset of pain. "Rest" includes such commonsense prescriptions as avoiding running or hiking (especially on hills), and avoiding exercises such as jumping jacks, sit-ups or leg lifts/flutter kicks.

Stretching of the tight structures (piriformis, hip abductor, and hip flexor muscle) may alleviate the symptoms. [8] The involved muscle is stretched (for 30 seconds), repeated three times separated by 30 second to 1 minute rest periods, in sets performed two times daily for six to eight weeks. [8] This should allow one to progress back into jogging until symptoms disappear. [8]

Injection based treatments

Injections are usually focused on the iliopsoas bursa. Corticosteroid injections are common, but usually only last weeks to months. In addition, corticosteroid side effects can include weight gain, weakening of the surrounding tissues, and even osteoporosis, with regular use. Cellular based therapy may have a role in future injection based treatments, though there is no current research proving the effectiveness of these therapies.[ citation needed ]

Surgical treatment

If medicine or physical therapy is ineffective or abnormal structures are found, surgery may be recommended.

Surgical treatment is rarely necessary unless intra-articular pathology is present. In patients with persistently painful iliopsoas symptoms surgical release of the contracted iliopsoas tendon has been used since 1984. [4] Iliopsoas and iliotibial band lengthening can be done arthroscopically. Postop, these patients will usually undergo extensive physical therapy; regaining full strength may take up to 9–12 months.[ citation needed ]

Rehabilitation

Patients may require intermittent NSAID therapy or simple analgesics as they progress in activities. If persistent pain caused by bursitis continues, a corticosteroid injection may be beneficial.[ citation needed ]

Physical therapy and rehabilitation

Both active and passive stretching exercises that include hip and knee extension should be the focus of the program. Stretching the hip into extension and limiting excessive knee flexion avoids placing the rectus femoris in a position of passive insufficiency, thereby maximizing the stretch to the iliopsoas tendon. Strengthening exercises for the hip flexors may also be an appropriate component of the program. A non-steroidal anti-inflammatory drug regimen as well as activity modification or activity progression (or both) may be used. Once symptoms have decreased a maintenance program of stretching and strengthening can be initiated. Light aerobic activity (warmup) followed by stretching and strengthening of the proper hamstring, hip flexors, and iliotibial band length is important for reducing recurrences. Conservative measures may resolve the problem in six to eight weeks.[ citation needed ].

Massage or self-myofascial release may be an effective intervention for external snapping hip syndromes. [2] It is suggested that using soft-tissue modalities to target the iliopsoas for medial extra-articulate snapping hip syndrome and gluteus maximus, tensor fasciae latae, and ITB complex for lateral extras-articulate snapping hip syndrome may be effective in treating symptoms of snapping hip syndrome. [2]

See also

Related Research Articles

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula.

Iliotibial band syndrome (ITBS) is the second most common knee injury, and is caused by inflammation located on the lateral aspect of the knee due to friction between the iliotibial band and the lateral epicondyle of the femur. Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. Risk factors in women include increased hip adduction and knee internal rotation. Risk factors seen in men are increased hip internal rotation and knee adduction. ITB syndrome is most associated with long-distance running, cycling, weight-lifting, and with military training.

<span class="mw-page-title-main">Knee</span> Leg joint in primates

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

<span class="mw-page-title-main">Piriformis muscle</span> Hip muscle in the lateral rotator group

The piriformis muscle is a flat, pyramidally-shaped muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group.

<span class="mw-page-title-main">Piriformis syndrome</span> Medical condition

Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle. It is a specific case of deep gluteal syndrome.

<span class="mw-page-title-main">Hip</span> Anatomical region between the torso and the legs, holding the buttocks and genital region

In vertebrate anatomy, the hip, or coxa in medical terminology, refers to either an anatomical region or a joint on the outer (lateral) side of the pelvis.

<span class="mw-page-title-main">Flexor hallucis longus muscle</span> One of the three deep muscles in the lower leg

The flexor hallucis longus muscle (FHL) attaches to the plantar surface of phalanx of the great toe and is responsible for flexing that toe. The FHL is one of the three deep muscles of the posterior compartment of the leg, the others being the flexor digitorum longus and the tibialis posterior. The tibialis posterior is the most powerful of these deep muscles. All three muscles are innervated by the tibial nerve which comprises half of the sciatic nerve.

<span class="mw-page-title-main">Iliopsoas</span> Joined psoas and iliacus muscles of the hip and thigh

The iliopsoas muscle refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter. It acts as the strongest flexor of the hip.

<span class="mw-page-title-main">Tensor fasciae latae muscle</span> Muscle of the thigh

The tensor fasciae latae is a muscle of the thigh. Together with the gluteus maximus, it acts on and is continuous with the iliotibial band, which attaches to the tibia. The muscle assists in keeping the balance of the pelvis while standing, walking, or running.

<span class="mw-page-title-main">Gluteal muscles</span> Group of three muscles which make up the buttocks

The gluteal muscles, often called glutes, are a group of three muscles which make up the gluteal region commonly known as the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and sacrum and insert on the femur. The functions of the muscles include extension, abduction, external rotation, and internal rotation of the hip joint.

<span class="mw-page-title-main">Muscles of the hip</span> Causes movement in the hip

In human anatomy, the muscles of the hip joint are those muscles that cause movement in the hip. Most modern anatomists define 17 of these muscles, although some additional muscles may sometimes be considered. These are often divided into four groups according to their orientation around the hip joint: the gluteal group; the lateral rotator group; the adductor group; and the iliopsoas group.

<span class="mw-page-title-main">Iliotibial tract</span> Longitudinal fibrous reinforcement of the fascia lata

The iliotibial tract or iliotibial band is a longitudinal fibrous reinforcement of the fascia lata. The action of the muscles associated with the ITB flex, extend, abduct, and laterally and medially rotate the hip. The ITB contributes to lateral knee stabilization. During knee extension the ITB moves anterior to the lateral condyle of the femur, while ~30 degrees knee flexion, the ITB moves posterior to the lateral condyle. However, it has been suggested that this is only an illusion due to the changing tension in the anterior and posterior fibers during movement. It originates at the anterolateral iliac tubercle portion of the external lip of the iliac crest and inserts at the lateral condyle of the tibia at Gerdy's tubercle. The figure shows only the proximal part of the iliotibial tract.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

<span class="mw-page-title-main">Golfer's elbow</span> Tendon inflammation disease of the elbow

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial common flexor tendon on the inside of the elbow. It is similar to tennis elbow, which affects the outside of the elbow at the lateral epicondyle. The tendinopathy results from overload or repetitive use of the arm, causing an injury similar to ulnar collateral ligament injury of the elbow in "pitcher's elbow".

Greater trochanteric pain syndrome (GTPS), a form of bursitis, is inflammation of the trochanteric bursa, a part of the hip.

<span class="mw-page-title-main">Calcaneal fracture</span> Medical condition

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

<span class="mw-page-title-main">Patellar dislocation</span> Medical condition

A patellar dislocation is a knee injury in which the patella (kneecap) slips out of its normal position. Often the knee is partly bent, painful and swollen. The patella is also often felt and seen out of place. Complications may include a patella fracture or arthritis.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Sacroiliac joint dysfunction</span> Abnormal motion in the sacroiliac joint of the pelvis

The term sacroiliac joint dysfunction refers to abnormal motion in the sacroiliac joint, either too much motion or too little motion, that causes pain in this region.

<span class="mw-page-title-main">Acetabular labrum tear</span> Injury of the acetabular labrum

An acetabular labrum tear or hip labrum tear is a common injury of the acetabular labrum resulting from a number of causes including running, hip dislocation, and deterioration with ageing. Most are thought to result from a gradual tear due to repetitive microtrauma.

References

  1. ↑ Morelli V, Espinoza L (March 2005). "Groin injuries and groin pain in athletes: part 2" (doc). Primary Care. 32 (1): 185–200. doi:10.1016/j.pop.2004.11.012. PMID   15831318.
  2. 1 2 3 4 Cheatham SW, Cain M, Ernst MP (October 2015). "Snapping Hip Syndrome". Strength and Conditioning Journal. 37 (5): 97–104. doi:10.1519/SSC.0000000000000161. S2CID   145932893.
  3. ↑ O'Kane JW (1999-10-15). "Anterior Hip Pain". American Family Physician. 60 (6): 1687–1696. PMID   10537384 . Retrieved 2007-02-12.
  4. 1 2 3 Micheli LJ, Solomon R (March 1997). "Treatment of recalcitrant iliopsoas tendinitis in athletes and dancers with corticosteroid injection under fluoroscopy" (PDF). Journal of Dance Medicine & Science. 1 (1): 7–11. doi:10.1177/1089313X9700100102. Archived from the original (PDF) on September 29, 2007. Retrieved 19 January 2007.
  5. ↑ Gupta A, Fernihough B, Bailey G, Bombeck P (13 May 2004). "The functional anatomy of the iliopsoas muscle and its implications for hip and back injury in dancers" (PDF). Curtin University of Technology. p. 1. Archived from the original (PDF) on 29 September 2007. Retrieved 19 January 2007.
  6. ↑ Garry JP, Talavera F, White RD (9 January 2023). "External snapping hip syndrome". Medscape.
  7. 1 2 Musick SR, Varacallo M (2019), "Snapping Hip Syndrome", StatPearls, StatPearls Publishing, PMID   28846235 , retrieved 2019-03-12
  8. 1 2 3 "Snapping hip syndrome" (PDF). Munson Army Health Center (MAHC). U.S. Army. Archived from the original (PDF) on 11 November 2017.
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