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Review
. 2015 Dec;23(4):194-9.
doi: 10.1097/JSA.0000000000000095.

Understanding and Treating the Snapping Hip

Yi-Meng Yen  1 , Cara L Lewis, Young-Jo Kim
Affiliations
Review

Understanding and Treating the Snapping Hip

Yi-Meng Yen et al. Sports Med Arthrosc Rev. 2015 Dec.

Abstract

Snapping hip, or coxa saltans is a palpable or auditory snapping with movement of the hip joint. Extra-articular snapping is divided into external and internal types, and is caused laterally by the iliotibial band and anteriorly by the iliopsoas tendon. Snapping of the iliopsoas usually requires contraction of the hip flexors and may be difficult to distinguish from intra-articular coxa saltans. Ultrasound can be a useful modality to dynamically detect tendon translation during hip movement to support the diagnosis of extra-articular snapping. Coxa saltans is typically treated with conservative measures including anti-inflammatories, stretching, and avoidance of inciting activities. Recalcitrant cases are treated with surgery to lengthen the iliopsoas or the iliotibial band.

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Figures

Figure 1
Figure 1
Drawing of lateral anatomy. The iliotibial band, greater trochanter of the femur, gluteus maxiumus and tensor fascia lata are labelled.
Figure 2
Figure 2
Drawing of anterior anatomy. The left side illustrates the muscle belly of the Iliacus and Psoas Major which form the conjoined iliopsoas tendon. The right side shows a bony prominence that may facilitate the snapping of the iliopsoas tendon during hip movement.
Figure 3
Figure 3
Drawing of snapping of coxa saltans interna. As the hip moves from a position of hip flexion, abduction, and external rotation (left) to hip extension, adduction, and internal rotation (right), the iliopsoas tendon passes over the iliopectineal eminence, a potential site of coxa saltans interna.
Figure 4
Figure 4
A) Intra-operative fluoroscopy with hip in internal rotation. Spinal needle is placed at the apex of the greater trochanter. Camera and arthroscopic radiofrequency device are seen at the level of the iliotibial band. B) Arthroscopic view of a right sideiliotibial band during release longitudinally with electrocautery device, Camera is in a proximal peritrochanteric portal and the electrocautery device is placed from a distal peritrochanteric portal. C) Longitudinal incision of the ITB with trochanteric bursa visible.
Figure 4
Figure 4
A) Intra-operative fluoroscopy with hip in internal rotation. Spinal needle is placed at the apex of the greater trochanter. Camera and arthroscopic radiofrequency device are seen at the level of the iliotibial band. B) Arthroscopic view of a right sideiliotibial band during release longitudinally with electrocautery device, Camera is in a proximal peritrochanteric portal and the electrocautery device is placed from a distal peritrochanteric portal. C) Longitudinal incision of the ITB with trochanteric bursa visible.
Figure 4
Figure 4
A) Intra-operative fluoroscopy with hip in internal rotation. Spinal needle is placed at the apex of the greater trochanter. Camera and arthroscopic radiofrequency device are seen at the level of the iliotibial band. B) Arthroscopic view of a right sideiliotibial band during release longitudinally with electrocautery device, Camera is in a proximal peritrochanteric portal and the electrocautery device is placed from a distal peritrochanteric portal. C) Longitudinal incision of the ITB with trochanteric bursa visible.
Figure 5
Figure 5
A) Arthroscopic view a left hip with the medial labrum. Note the ecchymosis and bruising of the medial labrum. Camera is in the standard antero-lateral portal and instrument is in the mid-anterior portal. B) Medial exposure of the liliopsoas tendon at level of the rim of the acetabulum. C) Same view as Figure 5B following release of the iliopsoas
Figure 5
Figure 5
A) Arthroscopic view a left hip with the medial labrum. Note the ecchymosis and bruising of the medial labrum. Camera is in the standard antero-lateral portal and instrument is in the mid-anterior portal. B) Medial exposure of the liliopsoas tendon at level of the rim of the acetabulum. C) Same view as Figure 5B following release of the iliopsoas
Figure 5
Figure 5
A) Arthroscopic view a left hip with the medial labrum. Note the ecchymosis and bruising of the medial labrum. Camera is in the standard antero-lateral portal and instrument is in the mid-anterior portal. B) Medial exposure of the liliopsoas tendon at level of the rim of the acetabulum. C) Same view as Figure 5B following release of the iliopsoas
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