Snapping Hip Syndrome: Difference between revisions
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Snapping Hip Syndrome is most often found in individuals between the ages of 15 and 40. It is thought to occur more frequently in females than men, with external snapping hip syndrome being the most common origin. The nature of this condition is typically an overuse injury, with a higher occurrence in activities that involve repetitive hip flexion and extension, such as dance, soccer, gymnastics and running.<br> | Snapping Hip Syndrome is most often found in individuals between the ages of 15 and 40. It is thought to occur more frequently in females than men, with external snapping hip syndrome being the most common origin. The nature of this condition is typically an overuse injury, with a higher occurrence in activities that involve repetitive hip flexion and extension, such as dance, soccer, gymnastics and running.<br> | ||
== Characteristics/Clinical Presentation | == Characteristics/Clinical Presentation == | ||
Most cases of SHS are benign and common to the general population. Symptomatic people may experience pain or weakness during hip flexion and extension that limits participation in their activities. () | Most cases of SHS are benign and common to the general population. Symptomatic people may experience pain or weakness during hip flexion and extension that limits participation in their activities. () | ||
*'''External <br>'''People with external SHS will usually have a gradual onset of snapping or pain located laterally over the greater trochanter. The external type is not associated with a traumatic event, but there can be a minor MOI. () The clinical presentation is often easily observable by watching and listening for snap as the patient actively flexes and extends the hip. These patients may describe a sense that the hip is dislocating. () People with external SHS may also have coxa vara, fibrotic scar tissue, a prominent greater trochanter, smaller lateral pelvic width, or a past surgery for anterolateral knee instability. ()() | *'''External <br>'''People with external SHS will usually have a gradual onset of snapping or pain located laterally over the greater trochanter. The external type is not associated with a traumatic event, but there can be a minor MOI. () The clinical presentation is often easily observable by watching and listening for snap as the patient actively flexes and extends the hip. These patients may describe a sense that the hip is dislocating. () People with external SHS may also have coxa vara, fibrotic scar tissue, a prominent greater trochanter, smaller lateral pelvic width, or a past surgery for anterolateral knee instability. ()() | ||
*'''Internal <br>''' | *'''Internal <br>'''Internal SHS also has a gradual onset, not usually associated with a traumatic event. () These patients describe a painful sensation coming from deep within the anterior groin as they move their leg from flexion into extension or external rotation. The snapping movement can produce an auditory clunk or click. () | ||
*'''Intra-articular <br>'''Patients with Intra-articular SHS report a sudden onset of snapping or clicking from an injury or traumatic event to the hip capsule. The sources of this snapping can come from intracapsular lesions, loose bodies settling in the acetabular fovea or synovial folds, a torn acetabular labrum, synovial chondromatosis, or a history of habitual hip dislocation in children or idiopathic recurrent subluxation. () | |||
*'''Intra-articular''' | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Revision as of 20:58, 10 July 2011
Lead Editors - John Fite, Tre Hinejosa, Jacqueline Keller, Elizabeth Record, John Winkelhaus,
Search Strategy[edit | edit source]
Search Timeline: June 10-
Databases Searched: Cinahl, Cochrane Library, Medline, PubMed, JOSPT,
Keywords: snapping hip syndrome, conservative management, physical therapy, physiotherapy, coxa saltans, tendinosis management, iliotibial band syndrome, iliopsoas tendon
Definition/Description
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Snapping Hip Syndrome, also known as Coxa Saltans, is a condition that is characterized by a snapping sensation, and/or audible “snap” or “click” noise, in or around the hip when it is in motion. There are various causes for snapping hip syndrome, which can be further classified as external, internal, or intra-articular in origin. For most people this condition is simply an annoyance; however it may result in both pain and weakness interfering with the patient’s functional mobility.
Epidemiology/Etiology[edit | edit source]
Snapping Hip Syndrome is most often found in individuals between the ages of 15 and 40. It is thought to occur more frequently in females than men, with external snapping hip syndrome being the most common origin. The nature of this condition is typically an overuse injury, with a higher occurrence in activities that involve repetitive hip flexion and extension, such as dance, soccer, gymnastics and running.
Characteristics/Clinical Presentation[edit | edit source]
Most cases of SHS are benign and common to the general population. Symptomatic people may experience pain or weakness during hip flexion and extension that limits participation in their activities. ()
- External
People with external SHS will usually have a gradual onset of snapping or pain located laterally over the greater trochanter. The external type is not associated with a traumatic event, but there can be a minor MOI. () The clinical presentation is often easily observable by watching and listening for snap as the patient actively flexes and extends the hip. These patients may describe a sense that the hip is dislocating. () People with external SHS may also have coxa vara, fibrotic scar tissue, a prominent greater trochanter, smaller lateral pelvic width, or a past surgery for anterolateral knee instability. ()()
- Internal
Internal SHS also has a gradual onset, not usually associated with a traumatic event. () These patients describe a painful sensation coming from deep within the anterior groin as they move their leg from flexion into extension or external rotation. The snapping movement can produce an auditory clunk or click. ()
- Intra-articular
Patients with Intra-articular SHS report a sudden onset of snapping or clicking from an injury or traumatic event to the hip capsule. The sources of this snapping can come from intracapsular lesions, loose bodies settling in the acetabular fovea or synovial folds, a torn acetabular labrum, synovial chondromatosis, or a history of habitual hip dislocation in children or idiopathic recurrent subluxation. ()
Differential Diagnosis
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- Intra-articular Hip Disorders
- Trochanteric Bursitis
- Iliopsoas_Bursitis
- Iliotibial Band Syndrome
- Iliopsoas Syndrome: a hip pathology characterized by internal snapping hip, iliopsoas tendonitis, and iliopsoas bursitis
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Compared to the body of literature for surgical management, there is a lack of evidence for specific interventions in the conservative management of snapping hip syndrome and/or tendonitis of the involved structures. Given that this condition is classified as a syndrome, the physical therapist can expect to find multiple abnormalites, each of which should be individually addressed. Examination findings of each individual patient should guide the impairment-based approach to treatment.
Since the mechanism of injury and focus of surgical intervention has been identified as excessive shortening and tightness of the iliopsoas tendon and iliotibial band, patients may benefit from stretching of anterior hip structures or the iliotibial band and its associated structures. [1] [2] [3]
Andres et al conducted a systematic review of interventions for tendonitis, and determined that eccentric strengthening exercises showed the greatest value in decreasing pain and increasing function, when compared to other physical therapy interventions.[4]
A case study has been published which documents the complete resolution of pain in a case of lateral coxa saltans. Myofascial release of the tensor fascia latae, gluteus medius, and gluteus maximus, and adductor musculature was performed, and the patient was prescribed a general stabilization and strengthening program focusing on the abductor musculature.[5]
A systematic review by the Cochrane Library showed no increased benefit of transverse friction massage, when compared to other interventions, for iliotibial band friction syndrome.[6]
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed) [edit | edit source]
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References[edit | edit source]
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- ↑ Byrd JW. Snapping Hip. Oper Tech Sports Med. 2005: 13:46-54
- ↑ Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990; 18 (5): 470-4
- ↑ Gose JC, Schweizer P. Iliotibial Band Tightness. J Orthop Sports Phys Ther. 10(10):399-407
- ↑ Andres BM, Murrell GA. Treatment of Tendinopathy. What Works, What Does Not, and What is on the Horizon. Clin Orthop Relat Res. (2008) 466:1539-1554
- ↑ Spina AA. External coxa sultans (snapping hip) treated with active release techniques: a case report. J Can Chiropr Assoc. 2007; 51(1):23-29
- ↑ Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis (Review). Cochrane Library 2009; 1
