Snapping Hip

CHAPTER 21

Snapping Hip

Introduction/Etiology/Epidemiology

• Snapping hip is an audible, sometimes painful, snapping sensation in the hip area.

• Snapping may be internal or external.

• Internal snapping hip (discussed in Chapter 22, Femoroacetabular Impingement) is caused by pathologies within the joint, such as labral tears or loose bodies.

• External snapping hip (discussed herein), also referred to as “coxa saltans” or “dancer’s hip,” is caused by pathology outside the joint. The 2 types of extra-articular snapping hip are as follows:

— External snapping hip (coxa saltans externa): a tight or inflamed iliotibial (IT) band snaps across the greater trochanter.

— Internal snapping hip (coxa saltans interna): a tight or inflamed iliopsoas tendon subluxates over the iliopectineal eminence or anterior aspect of the femoral head (Figures 21-1 and 21-2).

Figure 21-1. A portion of the psoas, running outside the joint (in most cases), becomes symptomatic, in that it tightens, causing it to snap (internal snapping hip) across the iliopectineal eminence, the rim of the acetabulum, or the femoral head. The psoas itself can become painful from this repetitive motion. In other cases, the psoas compresses the labrum, resulting in compression and sometimes tearing of the labral tissue due to the close proximity of the 2 structures.

Figure 21-2. Fifteen-year-old girl with snapping left hip, referred for magnetic resonance imaging to see if snapping is intra-articular (usually due to a labral tear) or extra-articular in origin. A, Oblique axial T2-weighted image reveals local soft tissue edema (red arrow) associated with the iliopsoas tendon (yellow arrow). B, Oblique coronal T2-weighted image confirms the edema (red arrows) tracking along the iliopsoas tendon (yellow arrow).

Courtesy Vic David, MD.

— Internal snapping hip can present similarly to intra-articular hip pathology because both cause anterior hip pain; however, it can be differentiated in most cases by physical examination.

• The snapping sensation can be painful, painless, and/or cause a sensation of relief.

• It can be unilateral or bilateral.

• It is most commonly caused by overuse; however, it can be precipitated by trauma.

• It usually presents during the adolescent growth spurt and is more common in girls than boys.

• Incidence is highest in athletes who perform repetitive hip flexion, such as gymnasts and dancers.

• A study of elite adolescent ballet dancers reported 91% of dancers had snapping hip, almost 80% of whom had bilateral symptoms.

External Snapping Hip

SIGNS AND SYMPTOMS

• Patients report pain or audible snapping on the lateral aspect of the hip with flexion and external rotation.

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