Snapping Hip

Snapping Hip Syndrome¹‚² is a condition in which a snapping sound or sensation—caused by a tendon or band of tissue rubbing over a bony prominence such as the greater trochanter—happens with hip movement. It is estimated that 5-10% of the population experiences Snapping Hip, with nearly 90% of competitive dancers affected.²

The hip is the largest ball-and-socket joint in the body and can move in multiple directions. The acetabulum of the pelvis forms the socket, while the femoral head (upper end of femur/thigh bone) creates the ball. A thick band of tissue called the iliotibial band runs along the outside of the leg from the hip to below the knee. It aids in hip extension, hip abduction, and lateral hip rotation. The iliopsoas tendon combines the psoas and iliacus muscles and attaches them to the lesser tuberosity of the femur—the iliopsoas muscle aids in hip flexion and external rotation.

Causes

Tightness in the muscles and tendons around the hip causes Snapping Hip. This is most often caused by overuse (most common in athletes and dancers), but it can be caused by trauma, injections to the muscles of the area, and following procedures like a total hip replacement. Snapping Hip is categorized by whether the source is external or internal. External Snapping Hip happens when the iliotibial band glides over the greater trochanter. Internal Snapping Hip occurs when the iliopsoas tendon glides over the femoral head, the iliopectineal eminence (a bony prominence of the pelvis), the iliopsoas bursa, or the lesser trochanter.

Symptoms

Though often uncomfortable, Snapping Hip is not always painful. The most common symptom is the sensation of the tendon or tissue passing over a bony prominence. Specific motions such as hip flexion or extension will create pain when irritated and painful.

Diagnosing

The diagnostic process includes a physical examination and a complete medical history. During the exam, your physician will pinpoint the area of pain to locate the origin. Most patients can point out the location of pain and recreate the “snap” with a particular motion. Sometimes, diagnostic testing is required to pinpoint the exact cause of the Snapping Hip.

X-rays rarely confirm the diagnosis of Snapping Hip, but they help rule in/out other hip problems. An injection using an anesthetic such as lidocaine can aid in determining whether the Snapping Hip is internal or external. An MRI or ultrasound can be used to visualize the affected anatomy.

Treatments

Conservative treatment is often all that is needed for relief and a return to regular activity. However, there are some cases in which pain and function do not improve with non-operative treatment, and more invasive procedures are necessary.

Conservative Treatment Options

When discomfort is affecting your lifestyle, your orthopedic specialist can recommend some conservative treatment options you can do at home.

Reduce or modify activity, especially the repetitive activity that causes the most discomfort/pain.
Use ice following activity to reduce inflammation and pain.
Take oral nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen to reduce inflammation and pain.
Physical Therapy, including home exercises that focus on stretching and strengthening the hip musculature.
If the Snapping Hip has led to bursitis, a corticosteroid injection can reduce pain and inflammation in the affected bursa.

Surgical Treatment

Most Snapping Hip occurrences respond well to conservative treatment. In the cases in which nonsurgical treatment is ineffective, surgery may be necessary. Your surgeon will discuss options and outcomes before scheduling a procedure. Pain relief from external Snapping Hip is often found in loosening the iliotibial band by lengthening or completely releasing it. Internal Snapping Hip treatment includes lengthening or releasing the iliopsoas tendon.

Hip Arthroscopy: Also called a “scope” or “keyhole surgery”, the surgeon makes a few small portal incisions and uses a small camera (arthroscope) to visualize the hip anatomy. This is often used to repair and remove fragments in the hip joint, such as the labrum.
Open Surgery: When the cause of the Snapping Hip is not visible on a scope or when a significant injury requires a more involved repair, the surgeon may need to make a larger incision to visualize the area.

Complications

All surgical procedures come with risks: pain, bleeding, nerve damage, and wound problems. Your orthopedic surgeon will discuss risks and possible complications before surgery. Depending on the extent of the release or trauma to the area, complications following the release of the iliotibial band can lead to weakness in hip abduction. In contrast, releasing the iliopsoas tendon can lead to weakness in hip flexion.

References:

Alaia, MD, FAAOS MJ. Snapping Hip. Ortho Info. Published May 2010. https://orthoinfo.aaos.org/en/diseases–conditions/snapping-hip/
Musick SR, Varacallo M. Snapping Hip Syndrome. Nih.gov. Published April 16, 2019. https://www.ncbi.nlm.nih.gov/books/NBK448200/