Snappy Hip Syndrome, or Coxa Saltans, is an audible or palpable snapping sensation that is heard during movement of the hip joint. Though this syndrome affects only 5% to 10% of the population, it occurs more in women than men. Fortunately, most patients experience painless snappy hips. The groups that are mainly affected are ballet dancers, weightlifters, soccer players, and runners due to overuse, trauma, intramuscular injections into the gluteus maximus, or surgical procedures. Snappy hip syndrome is classified into 3 main categories based on anatomical structure that causes the source of the snapping sensation. These categories are internal, external, and intra-articular labral tears of the hip. External snappy hip is caused by the iliotibial band (IT band) moving over the greater trochanter of the femoral head during hip movement in flexion, extension, and external or internal rotation of the hip. Internal snappy hip is caused by the proximal hamstring tendon rolling over the ischial tuberosity, the fascia lata, or the anterior gluteus maximus muscle rolling over the greater trochanter, and the psoas tendon rolling over the fibers of the iliacus muscle. Finally, the intra-articular snappy hip is caused by a labral tear in the cartilage of the acetabulum.
Diagnosis of this syndrome is confirmed using iliopsoas bursograpy combined with fluoroscopy, ultrasound, magnetic resonance imagery (MRI) or magnetic resonance angiography (MRA). An external snappy can be clinically diagnosed visibility on an MRI as a thickened IT band or thickened anterior edge of the gluteus maximus. If not visible, an ultrasound can be used to demonstrate the snapping on the iliotibial band over the greater trochanter. An ultrasound will be able to reveal tendonitis, iliopsoas bursitis, or muscle tears.
Treatment for snappy hip syndrome depends on the severity. When painless, treatment is not necessary. However, when pain is present, the treatment plan includes rest, stretching, steroid injections, oral NSAIDs, physical therapy, and modified physical activity. If pain continues, arthroscopic urgery may be necessary.
Figure 1. Painful hip skeleton X-ray
References
MDGRPHCS. (2020). [Illustration]. 3D illustration, hip painful skeleton x-ray, medical concept.
https://www.shutterstock.com/image-illustration/3d-illustration-hip-painful-skeleton-xray-1074188606
Musick SR & Varacallo M. (2020). Snapping Hip Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK448200/
Stanford Health Care. (2020). Snapping Hip Syndrome. https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/snapping-hip-syndrome.html