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Snapping Hip Syndrome

(Also referred to as coxa saltans, iliopsoas tendinitis, or dancer's hip)

What is snapping hip syndrome?
When you walk, get up from a chair, or swing your leg around, you may feel or hear a "snapping" sensation in your hip Snapping hip is usually painless and harmless, although the sensation can be annoying. Young athletes and dancers frequently experience snapping hip. There are several causes for snapping hip syndrome, most commonly due to tendons catching on bony prominences and "snapping" when the hip is moved.

What causes snapping hip syndrome?

The snapping sensation results from the movement of a muscle or tendon (the tough, fibrous tissue that connects muscle to bone) over a bony structure. In the hip, the most common site is at the outer side where a band of connective tissue (the iliotibial band) passes over the broad, flat portion of the thighbone known as the greater trochanter.
When the hip is straight, the band is behind the trochanter. When the hip bends, the band moves over the trochanter so that it is in front of it. The band is always tight, like a stretched rubber band. Because the trochanter juts out slightly, the movement of the band across it creates the snap you hear. Eventually, this could lead to hip bursitis. Bursitis is thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over bone.
Another tendon that could cause a snapping hip runs from the inside of the thighbone up through the pelvis (rectus femoris tendon). As you bend the hip, the tendon shifts across the head of the thighbone; when you straighten the hip, the tendon moves back to the side of the thighbone. This back-and-forth motion across the head of the thighbone causes the snapping.
A tear in the cartilage or debris in the hip joint can also cause a snapping or clicking sensation. This type of snapping hip usually causes pain and may be disabling. A loose piece of cartilage can cause the hip to catch or "lock up."
There are three primary causes for snapping hip syndrome:
  • Iliotibial Band Snap - The iliotibial band is a thick, wide tendon over the outside of the hip joint. The most common cause of snapping hip syndrome is when the Iliotibial band (or "IT band") snaps over the greater trochanter (the bony prominence over the outside of the hip joint). If this is the cause of snapping hip syndrome, patients may develop trochanteric bursitis from the irritation of the bursa in this region.
  • Iliopsoas Tendon Snap - The iliopsoas tendon is the primary hip flexor muscle, and the tendon of this muscle passes just in front of the hip joint. The iliopsoas tendon can catch on a bony prominence of the pelvis and cause a snap when the hip is flexed. Usually when the iliopsoas tendon is the cause of snapping hip syndrome, patients have no problems, but may find the snapping annoying.
  • Hip Labral Tear - The least common cause of snapping hip syndrome is a tear of the cartilage within the hip joint. If there is a loose flap of cartilage catching within the joint, this may cause a snapping sensation when the hip is moved. This cause of snapping hip syndrome typically causes a snapping sensation, but rarely an audible "pop." This cause of snapping hip syndrome may also cause an unsteady feeling, and patients may grab for support when the hip snaps.
Most people do not bother seeing a doctor for snapping hip unless they experience some pain. Your doctor will first determine the exact cause of the snapping. You may be asked where it hurts, what kinds of activities bring on the snapping, whether you can demonstrate the snapping, or whether you have experienced any trauma to the hip area.
You may also be asked to stand and move your hip in various directions to reproduce the snapping. The doctor may even be able to feel the tendon moving as you bend or extend your hip.
X-rays of people with snapping hip are typically normal, but they may be requested along with other tests so that the doctor can rule out any problems with the bones or joint.

Are any tests necessary to diagnose snapping hip syndrome?
An X-Ray is usually taken to confirm that there is no bony problem around the hip joint, but X-Rays are almost always normal with snapping hip syndrome. If the cause of snapping hip syndrome is thought to be due to a tear of the cartilage within the hip joint, an MRI may be obtained to look for evidence of this difficult to diagnose problem.

Is any treatment needed for snapping hip syndrome?
If your snapping hip is painless, no treatment is needed. If the snapping hip bothers you, but not to the point of seeing a doctor, try the following conservative home treatment options:
  • Reduce your activity levels and apply ice.
  • Use nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, to reduce discomfort.
  • Modify your sport or exercise activities to avoid repetitive movement of the hip. For example, reduce time spent on a bicycle, and swim using your arms only.
  • If you are still experiencing discomfort after trying these conservative methods, consult your physician for professional treatment.
  • Stretching exercises prescribed by your physician or a physical therapist can help reduce discomfort.
  • If you have hip bursitis, your physician may recommend an injection of a corticosteroid to reduce inflammation.
  • In the rare instances that snapping hip does not respond to conservative treatment, surgery may be recommended. The type of surgery will depend on the cause of the snapping hip; arthroscopy of the hip may be indicated.