Snapping Hip Syndrome

An audible clock or snapping sensation which may or may not be painful when the patients move the hip is known as snapping hip/coxa saltans or dancer’s hip. The snap is caused by the motion of muscles and tendons over the bony structures around the Hip joint. 

The sound/sensation occurs during activities such as walking, getting up from a chair, swinging leg, or engaging in sports activities involving the hip. An estimated 5-10% of the population is affected but is more common among athletes and active young teenagers/adults. The annoying snap over time develops into inflammation of the bursae around the hip resulting in pain during activities of daily living. 

Structures around the Hip joint

The hip joint is a large weight-bearing ball and socket joint. The ball is formed by the upper part of the thigh bone (femur), which fits into a socket formed by the pelvis (acetabulum). The socket is covered by tough tissue known as labrum, which seals the joint stabilizing it. 

The joint is also covered by ligaments that hold the joint in place. Tendons are tough tissues connecting muscles to the bones. Several tendons and muscles cross the Hip joint connecting the thigh bone to the pelvis. Bursae are fluid-filled bags that aid in smooth movement of the structures over the hip, providing a cushion. 

Causes & Symptoms

Athletes such as runners, soccer players, and heavy weight lifters engaging in repetitive motion around the hip joint are usually affected. 

Also, young adults and teenagers engaging in competitive or recreational activities such as ballet dancing or sports with repetitive motion often suffer from snapping hip. 

Certain surgeries performed about the hip or intramuscular injections in the buttock muscle can lead to snapping hip syndrome. Some patients with anatomical variations and tight muscle tendons are predisposed to the condition. 

Internal snapping

Snapping is caused by tendons passing in front of the Hip joint. The patients’ illicit audible snapping by bending and extending their affected hip, pointing at the area in front of the Hip with their finger. This type of snapping is due to the tendon of the iliopsoas and rectus femoris passing over the knobby head of the femur bone repeatedly.

External snapping

Patients usually report the visible movement of snapping of structures around the later side of the Hip joint. The iliotibial band (ITB) acts like a tight band moving from behind to front over the outer side of Hip while bending the hip. 

The greater trochanter is a projection on the outer side of the Hip joint, the ITB when tight moves and accompanies a snapping sensation. Over time the bursae overlying the greater trochanter becomes inflamed and causes pain. 

The hamstrings are a large group of muscles behind the Hip joint. The tendon can sometimes cause snapping sound when passing over the ischial tuberosity, also known as the sitting bone. 

Intra-articular

Labrum tears and foreign bodies inside the joint capsule cause snapping of the Hip joint. Snapping is usually accompanied by a locking sensation. The labrum and lose bodies cause physical obstruction to the movement of the Hip joint in some positions of the hip. 

Diagnosis

The doctor’s office visit involves a detailed history of the course of events and a physical examination. Diagnostic hip joint anesthesia injections may be used to differentiate and diagnose the cause of snapping. 

Imaging modalities such as X-rays, USG scans, CT scans, or MRI arthrograms may be used to diagnose the cause of snapping. 

Management

Depending upon the cause, treatment can be surgical or nonsurgical. Conservative or nonsurgical methods are usually the first line of treatment consisting of the following:

• Activities which precipitate the snapping are avoided or modified
• Painful bursitis is due to inflammation, which can be relieved with rest or user of over the counter medications such as Tylenol or Advil. 
• Corticosteroid injections are usually helpful in relieving inflammation and pain. 
• Physical therapy helps to strengthen the muscles around the hip, and stretching exercises relax the tight structures. Some of the exercises such as iliotibial stretch and piriformis stretch, can be performed at home.  

Surgical procedures are used to correct the anatomical variations and relieve tight structures to treat snapping hip syndrome. 

• Arthroscopic surgery is performed using a miniature camera, which is used to visualize the structures inside the hip which are projected on a big screen. The surgeon can guide miniature tools to relieve the structures or remove any loose bodies from the joint. The incisions are minute, and the procedure is daycare, patients walk home the same day. 
• Open procedures are done where arthroscopic procedures cannot be performed. The incisions can be several inches long. The tight structures are released and repaired with prolonged recovery time.  

Regardless of the treatment outcomes are good, and the majority of patients describe relief from symptoms. Schedule your visit with an orthopedic surgeon who specializes in arthroscopic procedures if you have any of the above symptoms.