Snapping Hip Syndrome
Ross Hauser, MD
In this article, Ross Hauser explains problems of Snapping Hip Syndrome.
In research from doctors in Poland, a detailed analysis of the diagnosis and determination of Snapping Hip Syndrome is given. Here is the summary of that research:
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- Snapping hip syndrome is an audible or palpable snap in a hip during movement which may be accompanied by pain, locking, or a sharp stabbing sensation.
- The diagnosis of Snapping Hip Syndrome should be give consideration in youth athletes where incidences are greater.
- The symptoms tend to occur more frequently among soccer players, weight lifters or runners, but the syndrome is the most common in ballet dancers.
- Snapping hip syndrome may follow a physical trauma, an intramuscular injection into the gluteus maximus muscle, a surgical knee reconstruction using a portion of the iliotibial band, or a total hip replacement.
There are two main forms of snapping hip: extra or intraarticular.
- Intra-articular hip pathologies include acetabular labral tears, cartilage defects, loose bodies floating in hips.
- Extra-articular snapping may occur in the to the side or front region of the hip, depending on which tendon is involved in the snapping movement.
- The lateral form of extra-articular snapping hip (external snapping hip) is caused by a movement of the iliotibial band or gluteus maximus across the greater trochanter. Conversely, the anterior form (internal snapping hip) is attributed to the iliopsoas tendon snapping over the iliopectineal eminence. 1
Finding an effective treatment for Snapping Hip Syndrome
Since snapping hip syndrome is commonly seen among athletes, the typical approach is to blame it on overtraining and tight muscles and tendons. As such, it involves at least part of the RICE protocol, which includes rest, ice, compression and elevation.
Although some of these treatment components do indeed help with muscle injuries, they do not heal heal the soft tissue involved such as the ligaments, tendons, and hip labrum.
In addition, athletes must also stop training immediately, advice that is rarely popular, and when ligament laxity is involved, not even necessary for very long.
Another standard practice involves the use of steroids and anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Long-term side effects of these drugs can lead to other systemic health concerns.
When all else fails, patients who experience chronic snapping hip syndrome may be referred to a surgeon in order to lengthen the “tight” tendons thought to be involved. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source.
The Iliotibial Band (IT Band) and iliopsoas tendon
Snapping hip syndrome involving the iliotibial band, or IT band.
- The IT Band is a thick, wide tendon that runs over the outside of the hip joint. Snapping hip syndrome occurs when the iliotibial band snaps over the bony prominence over the outside of the hip joint. Patients with this type of snapping hip syndrome may also develop trochanteric bursitis from the irritation of the bursa in this region.
Snapping hip syndrome involving the iliopsoas tendon,
- The iliopsoas tendon can catch on a bony prominence of the pelvis and cause a snap when the hip is flexed. When the iliopsoas tendon is the cause of snapping hip syndrome, patients typically experience no problems other than the annoying snapping.
Snapping hip syndrome involving involves a tear in the hip cartilage or bone debris in the hip joint (loose bodies). This type of snapping hip usually causes pain and may be disabling. In addition, a loose piece of cartilage can cause the hip to catch or lock up.
Prolotherapy for Snapping Hip Syndrome
A better approach is to strengthen the hip ligaments with Prolotherapy. Prolotherapy to the posterior hip capsule and ischiofemoral ligaments generally resolves the problem if the condition involves snapping of the iliotibial band or gluteal muscles, because posterior hip laxity is involved in these conditions.
Prolotherapy to the anterior hip ligaments, namely the ileofemoral ligament, will tighten the joint and stop the anterior protrusion of the hip. In other words, Prolotherapy helps resolve snapping hip syndrome because the underlying etiology of the problem is most often hip ligament laxity, and not tight muscles or tendons.
Snapping Hip due to Gluteus Medius Tendinopathy
Doctors from the National Tawain University Hospital presented a case of snapping hip syndrome in regards to gluteus medius and minimus tendon problems and dextrose prolotherapy in its treatment.
A 37-year-old male started to complain of right lateral hip pain after he had initiated weight training half a year ago. The physical examination revealed tenderness near the greater trochanteric region with a reproducible and palpable snapping during hip flexion and extension.
The ultrasound examination showed swelling and hypoechogenicity (a clear immune response to injury) in the gluteus medius tendon at its insertion (enthesis) on the lateral facet of the greater trochanter. The overlying iliotibial band appeared normal. In the short-axis view, a snapping was clearly visualized when the iliotibial band glided over the swollen gluteus medius tendon during hip flexion and extension.
Under US guidance, 25% dextrose solution was administered into the gluteus medius tendon (1.5 mL) using the peppering technique and into the space between the iliotibial band and the gluteus medius tendon (2.5 mL). After two cycles of dextrose injections in 2 weeks, the patient became free of hip pain and snapping.
The doctors also reported that they did not use corticosteroid due to its weak benefit in treating chronic tendinopathy and its detrimental effect on tendon healing.2
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1. Piechota M, Maczuch J, Skupiński J, Kukawska-Sysio K, Wawrzynek W. Internal snapping hip syndrome in dynamic ultrasonography. Journal of Ultrasonography. 2016;16(66):296-303. doi:10.15557/JoU.2016.0030.
2. Chen-Yu Hung, MD, Ke-Vin Chang, MD, Levent Özçakar, MD; Snapping Hip due to Gluteus Medius Tendinopathy: Ultrasound Imaging in the Diagnosis and Guidance for Prolotherapy. Pain Med 2015; 16 (10): 2040-2041.