Snapping Hip Syndrome

In this article, we describe all the common causes of snapping hip syndrome and the most effective ways to treat it. Everyone loves living a happy and healthy life without any inconveniences present to disturb them or stop them from enjoying life to the fullest.

However, at the same time, there are certain issues, particularly those involving our bones, joints, and ultimately – our mobility, that seems to be around the corner at all times.

You bend a little bit too much, stretch yourself way overboard, or even move your body around for longer than you usually do to keep it fit and healthy – and there, you have it. A new inconvenience, either in the form of a sprain, strain, muscle tear, or even a dislocated bone, that could land you in deep trouble for a long, long time.

Snapping Hip Syndrome is one of such inconveniences that can unexpectedly develop in a person. Most of the time, it is usually painless, but there is an underlying abnormality present that needs to be evaluated and treated.

What Is Snapping Hip Syndrome?

Snapping Hip Syndrome is a condition that is accompanied by an audible and sometimes palpable snapping sensation during the movement of the hip joint – the articulation between the acetabular cavity of the hip bone and the femoral head. This condition is also known as ‘Dancer’s Hip’ or ‘Coxa Saltans .’[1]

It is named so because out of the total 5-10% of the population that develops it, the majority are ballet dancers, competitive dancers, weight lifters, or soccer players.

All these people are involved in activities requiring continuous, repetitive motion of the side of the hip joint, so it is not a surprise if they develop a ‘snapping’ sound as a consequence of these actions and activities. [2]

Causes

We already know that there is a particular category of people, that is, those continuously using their upper part of the lower limb, who develop the Snapping Hip Syndrome.

However, this is not all about it. There are several other people as well who get affected due to other reasons. This fact tells us that other causes also lead to the development of the snapping hip. Some of the common causes include:

• Overuse:

This category includes all professional people who play soccer, do gymnastics, or dance. The continuous flexion and extension movements of their hip bone and the hip joint, in general, make it susceptible for it to develop this snapping, and so they ultimately have to suffer. In sports medicine, this is a commonly encountered condition. [3]

According to a study, it was found that about 90% of dancers who develop the Snapping Hip Syndrome develop it bilaterally (on both sides). Moreover, as compared to males, females were more predisposed to develop this condition during their lifetime. [4]

• Trauma: 

Sometimes, intramuscular injection in the hip region can also cause the Snapping Hip Syndrome to develop, showing that trauma to the soft tissues can also lead to this condition. Similarly, some surgical procedures such as total hip arthroscopy or knee reconstruction have also been seen to predispose a person to develop this condition. [5]

This happens when some part of the iliotibial band is used during the surgery, but unfortunately, this band gets tightened.

• Anatomical Variations: 

In some people, the anatomy of the hip and the hip joint is such that it compromises the normal width, space, and anatomical measurements that should otherwise be present in a healthy individual.

These people either have an increased distance between the greater trochanters of the femur bone, very prominent greater trochanters, shorter muscles or tendons, tightened iliotibial bands, narrow bi-iliac width, or suffer from conditions such as developmental dysplasia of the hip bone or the maldevelopment of the neck of the femur (thigh bone), leading to its narrowness, and ultimately the Snapping Hip Syndrome. [6]

The Development Of The Snapping Hip Syndrome: 

To understand how the Snapping Hip Syndrome actually develops in an otherwise normal and healthy individual, it is important to first learn that this condition was previously divided into two main types of snapping hip syndromes – intra-articular and extra-articular snapping hip.

However, this classification of the two types of snapping hip is now obsolete. Now, only the extra-articular variant of the Snapping Hip Syndrome is recognized, and that too is broken down into two further sub-types. This ultimately makes the condition easier to diagnose and eventually treat. [7]

Here is a brief overview of the two subtypes of extra-articular snapping hip:

External:

External Snapping Hip Syndrome occurs when the iliotibial band starts moving over the greater trochanter of the femur during the hip joint movement – such as during hip flexion, extension, and internal and external rotation (involving the piriformis muscle). [8]

At other times, it may occur when the proximal part of the hamstring tendon rolls over the ischial tuberosity (a pointed bony prominence of the hip bone).

External Snapping Hip may also occur due to a combination of more than one factor, such as the thickening of the anterior gluteus maximus (the main hip muscle) and the posterior iliotibial band, which contributes to the development of this condition. [9]

The person usually appears to have audible snapping when they flex and extend their hip. Patients are also likely to confuse this condition for hip dislocation because the snap sound could be misleading just like that.

Some of these patients also either have a developmental problem with their hips or lower limb or could have generally had a lower limb involving surgery in the past.

Internal:

The Internal Snapping Hip Syndrome occurs when the iliopsoas tendon snaps, involving the underlying bony structures present in its vicinity, such as the iliopectineal eminence and the anterior portion of the femur (thigh) bone. [10]

Sometimes, complete or partial bifurcation of the iliopsoas tendon or palpebral cysts present in this area can also contribute to the development of this condition.

Unlike External Snapping Hip, which may be accompanied by a traumatic event, Internal Snapping Hip usually develops gradually over time. The patients affected by this condition experience a clicking or clunking sound as they try to initiate some form of hip movement. [11]

This condition is painful for the patient, and the patient experiences a very painful sensation around the affected hip. As the person moves, they experience pain coming deep from the anterior groin region (resulting in groin pain). The hip flexors (including rectus femoris, iliopsoas muscle, pectineus, iliacus, and sartorius) are all in a compromised position where they cannot flex without causing pain towards the front of the hip.

Intra-articular Snapping Hip:

This type of snapping hip syndrome occurs suddenly and due to an unexpected injury to the hip capsule. It results in a sudden snapping or clicking sound. [12]

The hip capsule mainly comprises layers of ligaments that are thick everywhere, except for the underside of the capsule, where they ultimately become thinner. It may also occur due to tears sustained in the labrum – a cup-shaped cartilaginous area of the hip joint that articulates aligns, and strengthens the hip joint, where the head of the femur and the acetabulum meet to form the ball-and-socket type of hip joint.

Diagnosis and Evaluation Of Snapping Hip Syndrome:

It is easy to diagnose a condition such as Snapping Hip Syndrome, mainly because it can be observed from the outside of the hip without having to intervene invasively as well.

However, an orthopedic doctor will order plain radiographic imaging, such as an x-ray. These x-rays do not have the diagnostic value in this case – they just help exclude any doubts or suspicions the doctor might have while examining the patient. [13]

An MRI or ultrasonography has proven to be useful in this case. Onan MRI, a thickened iliotibial band, or a thickened anterior gluteus maximus muscle reveals the Snapping Hip Syndrome. On ultrasonography, other conditions such as tendinitis and bursitis (inflammation of the bursa) of the ilio-psoas tendon or labral tears in the associated areas can also be easily diagnosed.

Treatment Options For Snapping Hip Syndrome: 

There are several treatment options available for the treatment of Snapping Hip Syndrome. However, in most cases where Snapping Hip Syndrome manifests as an asymptomatic condition, it is unnecessary to use any treatment.

If the person suffers from mild to moderate pain along with the usual snapping sounds, then they may be recommended to opt for conservative treatment options, and those include:

• Physical therapy to ensure proper movement and alignment of the hip joint,

• A course of non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Naproxen – same treatment choice as in tendinitis,

• Corticosteroid Injections,

• Rest and icing/cold compresses,

• Immobilization of the joint and restricted movements.

In case the hip pain does not resolve or the patient experiences severe pain in the hip, then it is recommended that surgical treatment options should be considered.

According to the latest research and studies, it is now recommended that arthroscopic approaches should be considered in place of the traditional open methods as they allow better recovery rates and are associated with fewer complications as well. [14]

The type of Snapping Hip Syndrome a person suffers from determines the surgical treatment plan they should get done.

Therefore, some popular treatment approaches for External Snapping Hip Syndrome include making an elliptical resection of some part of the iliotibial band (ITB or IT Band), Z-plasty of the iliotibial tract, and resection of the posterior part of the iliotibial tract. [15]

Similarly, for Internal Snapping Hip Syndrome, releasing the ilio-psoas tendon completely, resecting a bony portion of the lesser trochanter, and lengthening the ilio-psoas tendon all seem to work in favor of resolving the condition. [16]

For intra-articular Snapping Hip Syndrome, treating the underlying condition, such as the loose bodies or other pathologies that lead to the development of this condition, helps in resolving the condition.

Prolotherapy

In recent years, prolotherapy has built its reputation within the medical community due to its clinically proven ability to treat snapping hip syndrome.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with small needles. This has been shown to reduce swelling, which helps with snapping hip syndrome.

As prolotherapy is helping to treat the root cause of snapping hip syndrome, it is deemed to be a permanent fix, preventing the symptoms from returning.

Conclusion: 

All in all, the Snapping Hip Syndrome is a very treatable condition. However, it might be super uncomfortable for people suffering from it – for hearing clicking, popping, or snapping sounds whenever you move your hip around is certainly not considered normal!

However, it is very easy to treat it. For persistent cases, surgery does the job and ensures a symptom and pain-free life for the affected individual. Arthroscopy has indeed changed the world for the affected people and allows them to get treated with lesser complications.

References: 

1. Musick SR, Varacallo M. Snapping Hip Syndrome. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448200/
2. Yen, Y. M., Lewis, C. L., & Kim, Y. J. (2015). Understanding and Treating the Snapping Hip. Sports medicine and arthroscopy review, 23(4), 194–199.
3. Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088.
4. Badowski, E. (2018). Snapping hip syndrome. Orthopaedic Nursing, 37(6), 357-360.
5. Lewis C. L. (2010). Extra-articular Snapping Hip: A Literature Review. Sports health, 2(3), 186–190.
6. Musick, S. R., & Varacallo, M. (2017). Snapping hip syndrome.
7. Allen, W. C., & Cope, R. (1995). Coxa saltans: the snapping hip revisited. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 3(5), 303-308.
8. Lewis, C. L. (2010). Extra-articular snapping hip: a literature review. Sports health, 2(3), 186-190.
9. Cheatham, S. W. (2016). Extra-articular hip impingement: a narrative review of the literature. The Journal of the Canadian Chiropractic Association, 60(1), 47.
10. Piechota, M., Maczuch, J., Skupiński, J., Kukawska-Sysio, K., & Wawrzynek, W. (2016). Internal snapping hip syndrome in dynamic ultrasonography. Journal of Ultrasonography, 16(66), 296.
11. Ilizaliturri Jr, V. M., Suarez-Ahedo, C., & Acuña, M. (2015). Internal snapping hip syndrome: incidence of multiple-tendon existence and outcome after endoscopic transcapsular release. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(10), 1991-1995.
12. Ilizaliturri Jr, V. M., Villalobos Jr, F. E., Chaidez, P. A., Valero, F. S., & Aguilera, J. M. (2005). Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 21(11), 1375-1380.
13. Ilizaliturri Jr, V. M., Chaidez, C., Villegas, P., Briseño, A., & Camacho-Galindo, J. (2009). Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25(2), 159-163.
14. Kyin, C., Maldonado, D. R., Go, C. C., Shapira, J., Lall, A. C., & Domb, B. G. (2021). Mid-to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 37(3), 1011-1025.
15. Randelli, F., Mazzoleni, M. G., Fioruzzi, A., Giai Via, A., Calvisi, V., & Ayeni, O. R. (2021). Surgical interventions for external snapping hip syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 29(8), 2386-2393.
16. Hwang, D. S., Hwang, J. M., Kim, P. S., Rhee, S. M., Park, S. H., Kang, S. Y., & Ha, Y. C. (2015). Arthroscopic treatment of symptomatic internal snapping hip with combined pathologies. Clinics in Orthopedic Surgery, 7(2), 158-163.