Snapping hip syndrome
Encyclopedia
Snapping hip syndrome is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by an audible snapping or popping noise and pain
or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is classified by location of the snapping, either extra-articular or intra-articular.
(knee toward waist) to extension
(knee down and hip joint straightened). After extended exercise pain or discomfort may be present caused by inflammation of the iliopsoas bursae
. Pain often decreases with rest and diminished activity. Symptoms usually last months or years without treatment and can be very painful.
The more common lateral extra articular type of snapping hip syndrome occurs when the iliotibial band
, tensor fascia lata, or gluteus medius tendon slides back and forth across the greater trochanter
. This normal action becomes a snapping hip syndrome when one of these connective tissue bands thickens and catches with motion. The underlying bursa may also become inflamed, causing a painful external snapping hip syndrome.
Less commonly, the iliopsoas
tendon catches on the anterior inferior iliac spine (AIIS), the lesser trochanter
, or the iliopectineal ridge during hip extension, as the tendon moves from an anterior lateral (front, side) to a posterior medial (back, middle) position. With overuse, the resultant friction may eventually cause painful symptoms, resulting in muscle trauma, bursitis
, or inflammation in the area.
In athletes such as ballet dancers, gymnasts, horse riders, track and field athletes and soccer players, military training, or any vigorous exerciser, repeated hip flexion leads to injury. In excessive weightlifting or running, the cause is usually attributed to extreme thickening of the tendons in the hip region. Snapping hip syndrome most often occurs in persons who are 15 to 40 years old.
, recurrent hip subluxation
, ligamentum teres tears, loose bodies, articular cartilage damage, or synovial chondromatosis
(cartilage formations in the synovial membrane of the joint).
Correcting any contributing biomechanical
abnormalities and stretching tightened muscles, such as the iliopsoas muscle or iliotibial band, is the goal of treatment to prevent recurrence.
Referral to an appropriate professional for an accurate diagnosis is necessary if self treatment is not successful or the injury is interfering with normal activities. Medical treatment of the condition requires determination of the underlying pathology and tailoring therapy to the cause. The examiner may check muscle-tendon length and strength, perform joint mobility testing, and palpate the affected hip over the greater trochanter for lateral symptoms during an activity such as walking.
(Hydration, Ibuprofen, Rest, Ice, Compression, Elevation) regimen lasting for at least 48 to 72 hours after the onset of pain. "Rest" includes such commonsense prescriptions as avoiding running or hiking (especially on hills), and avoiding exercises such as baseball, jumping, sit-ups or leg lifts/flutter kicks.
Stretching of the tight structures (piriformis, hip abductor, and hip flexor muscle) may alleviate the symptoms (see link, pg. 3, for examples) The involved muscle is stretched (for 30 seconds), repeated three times separated by 30 second to 1 minute rest periods, in sets performed two times daily for six to eight weeks. This should allow the soldier to progress back into jogging until symptoms disappear.
Surgical treatment is rarely necessary unless intra-articular pathology is present. In patients with persistently painful iliopsoas symptoms surgical release of the contracted iliopsoas tendon has been used since 1984.
injection may be beneficial.
avoids placing the rectus femoris in a position of passive insufficiency, thereby maximizing the stretch to the iliopsoas
tendon. Strengthening exercises for the hip flexors
may also be an appropriate component of the program. Education, a non-steroidal anti-inflammatory drug
regimen, as well as activity modification or activity progression (or both) may be used. Once symptoms have decreased a maintenance program of stretching and strengthening can be initiated. Light aerobic activity (warmup) followed by stretching and strengthening of the proper hamstring
, hip flexors, and iliotibial band length is important for reducing recurrences.
Conservative measures generally resolve the problem in 6 to 8 weeks.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is classified by location of the snapping, either extra-articular or intra-articular.
Symptoms
An audible snapping or popping noise as the tendon at the hip flexor crease moves from flexionFlexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
(knee toward waist) to extension
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
(knee down and hip joint straightened). After extended exercise pain or discomfort may be present caused by inflammation of the iliopsoas bursae
Bursa (anatomy)
A bursa is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of slimy fluid . It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement...
. Pain often decreases with rest and diminished activity. Symptoms usually last months or years without treatment and can be very painful.
Extra-articular
- Lateral extra articular
The more common lateral extra articular type of snapping hip syndrome occurs when the iliotibial band
Iliotibial tract
The iliotibial tract or iliotibial band is a longitudinal fibrous reinforcement of the fascia lata. It is attached to the anterolateral iliac tubercle portion of the external lip of the iliac crest and to the lateral condyle of the tibia...
, tensor fascia lata, or gluteus medius tendon slides back and forth across the greater trochanter
Greater trochanter
The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system.It is directed a little lateralward and backward, and, in the adult, is about 1 cm lower than the head...
. This normal action becomes a snapping hip syndrome when one of these connective tissue bands thickens and catches with motion. The underlying bursa may also become inflamed, causing a painful external snapping hip syndrome.
- Medial extra-articular
Less commonly, the iliopsoas
Iliopsoas
-External links:*...
tendon catches on the anterior inferior iliac spine (AIIS), the lesser trochanter
Lesser trochanter
The lesser trochanter of the femur is a conical eminence, which varies in size in different subjects-Anatomy:It projects from the lower and back part of the base of the femur neck.From its apex three well-marked borders extend:...
, or the iliopectineal ridge during hip extension, as the tendon moves from an anterior lateral (front, side) to a posterior medial (back, middle) position. With overuse, the resultant friction may eventually cause painful symptoms, resulting in muscle trauma, bursitis
Bursitis
Bursitis is the inflammation of one or more bursae of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless...
, or inflammation in the area.
Causes of Injury
Athletes are at special risk for snapping hip syndrome due to repetitive and physically demanding movements.In athletes such as ballet dancers, gymnasts, horse riders, track and field athletes and soccer players, military training, or any vigorous exerciser, repeated hip flexion leads to injury. In excessive weightlifting or running, the cause is usually attributed to extreme thickening of the tendons in the hip region. Snapping hip syndrome most often occurs in persons who are 15 to 40 years old.
Extra-articular snapping hip syndrome
Extra-articular snapping hip syndrome is commonly associated with leg length difference (usually the long side is symptomatic), tightness in the iliotibial band (ITB) on the involved side, weakness in hip abductors and external rotators, poor lumbopelvic stability and abnormal foot mechanics (Overpronation). Popping occurs when the thickened posterior aspect of the ITB or the anterior gluteus maximus rubs over the greater trochanter as the hip is extended.Intra-articular snapping hip syndrome
Similar causes as extra-articular snapping hip syndrome but often with an underlying mechanical problem in the lower extremity. The pain associated with internal variety tends to be more intense and therefore more debilitating than the external variety. Intra-articular snapping hip syndrome is often indicative of injury such as a torn acetabular labrumAcetabular labrum
The acetabular labrum is a ring of cartilage that surrounds the acetabulum ....
, recurrent hip subluxation
Subluxation
A subluxation may have different meanings, depending on the medical specialty involved. It implies the presence of an incomplete or partial dislocation of a joint or organ. The World Health Organization defines both the medical subluxation and the chiropractic subluxation...
, ligamentum teres tears, loose bodies, articular cartilage damage, or synovial chondromatosis
Synovial chondromatosis
Synovial chondromatosis is a disease affecting the synovium, a thin flexible membrane around a joint. It is also known as Reichel's syndrome or Reichel-Jones-Henderson syndrome, named after Friedrich Paul Reichel, Hugh Toland Jones and Melvin Starkey Henderson.-Symptoms:Patients usually complain of...
(cartilage formations in the synovial membrane of the joint).
Treatment
This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern.Correcting any contributing biomechanical
Biomechanical
Biomechanical may refer to:*Biomechanics, the application of mechanical principles to living organisms*Biomechanics , system of actor training developed by Vsevolod Meyerhold*Biomechanical Art, the style of H. R...
abnormalities and stretching tightened muscles, such as the iliopsoas muscle or iliotibial band, is the goal of treatment to prevent recurrence.
Referral to an appropriate professional for an accurate diagnosis is necessary if self treatment is not successful or the injury is interfering with normal activities. Medical treatment of the condition requires determination of the underlying pathology and tailoring therapy to the cause. The examiner may check muscle-tendon length and strength, perform joint mobility testing, and palpate the affected hip over the greater trochanter for lateral symptoms during an activity such as walking.
Self-treatment
A self-treatment recommended by the U.S. Army for a soft tissue injury of the iliopsoas muscle treatment, like for other soft tissue injuries, is a HI-RICERICE (medicine)
RICE is a treatment method for soft tissue injury which is an acronym for Rest, Ice, Compression and Elevation. When used appropriately, recovery duration is usually shortened and discomfort minimized....
(Hydration, Ibuprofen, Rest, Ice, Compression, Elevation) regimen lasting for at least 48 to 72 hours after the onset of pain. "Rest" includes such commonsense prescriptions as avoiding running or hiking (especially on hills), and avoiding exercises such as baseball, jumping, sit-ups or leg lifts/flutter kicks.
Stretching of the tight structures (piriformis, hip abductor, and hip flexor muscle) may alleviate the symptoms (see link, pg. 3, for examples) The involved muscle is stretched (for 30 seconds), repeated three times separated by 30 second to 1 minute rest periods, in sets performed two times daily for six to eight weeks. This should allow the soldier to progress back into jogging until symptoms disappear.
Diagnostic Imaging
- Ultrasound during hip motion may visualize tendon subluxation and any accompanying bursitis when evaluating for iliopsoas involvement in medial extra-articular cases.
- MRI can sometimes identify intra-articular causes of snapping hip syndrome.
Injection Based Treatments
Injections are usually focused on the iliopsoas bursa. Corticosteroid injections are common, but usually only last weeks to months. in addition, corticosteroid side effects can include weight gain, weakening of the surrounding tissues, etc. Cellular based therapy may have a role in future injection based treatments, though there is no current research proving the effectiveness of these therapies.Surgical Treatment
If the patient does not respond well to medicine or physical therapy, or abnormal structures are found, surgery may be recommended.Surgical treatment is rarely necessary unless intra-articular pathology is present. In patients with persistently painful iliopsoas symptoms surgical release of the contracted iliopsoas tendon has been used since 1984.
Rehabilitation
Patients may require intermittent NSAID therapy or simple analgesics as they progress in activities. If persistent pain caused by bursitis continues a corticosteroidCorticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
injection may be beneficial.
Physical Therapy or Athletic Training Therapy and Rehabilitation
Both active and passive stretching exercises that include hip and knee extension should be the focus of the program. Stretching the hip into extension and limiting excessive knee flexionFlexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
avoids placing the rectus femoris in a position of passive insufficiency, thereby maximizing the stretch to the iliopsoas
Iliopsoas
-External links:*...
tendon. Strengthening exercises for the hip flexors
Hip flexors
In human anatomy, the hip flexors are a group of skeletal muscles that act to flex the femur onto the lumbo-pelvic complex, i.e., pull the knee upward....
may also be an appropriate component of the program. Education, a non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
regimen, as well as activity modification or activity progression (or both) may be used. Once symptoms have decreased a maintenance program of stretching and strengthening can be initiated. Light aerobic activity (warmup) followed by stretching and strengthening of the proper hamstring
Hamstring
In human anatomy, the hamstring refers to any one of the three posterior thigh muscles, or to the tendons that make up the borders of the space behind the knee. In modern anatomical contexts, however, they usually refer to the posterior thigh muscles, or the tendons of the semitendinosus, the...
, hip flexors, and iliotibial band length is important for reducing recurrences.
Conservative measures generally resolve the problem in 6 to 8 weeks.
Images
- Right hip-joint from the front
- Normal Hip X-Ray
External links
- Snapping Iliopsoas Tendon in a Recreational Athlete: A Case Report from National Center for Biotechnology Information (pdf)