SNAPPING HIP SYNDROME

Snapping Hip is a condition in which a “snap” is felt or heard at the hip level caused by sliding a muscle or tendon on a bony protrusion at the level of the hip joint. The cause can be due to a very pronounced bony protrusion or a very tight/shortened tendon, or both. Although it may not be painful at first, it can become symptomatic and end up causing degeneration of the affected tendon.
It is more frequent in women and athletes, especially in those sports that require repetitive hip flexion and rotation. It can also appear in activities of daily living such as when walking or getting up from a chair. The snapping hip can be external or internal; in other words, the problem can be inside the joint or on the tissue surrounding the joint. The “outside joint” problem arises from 2 muscles: the tensor fascia latae and the iliopsoas. They rub against bony prominences causing the symptoms. The “inside joint” problems are caused by: pieces of cartilage or bone, which are like pebbles inside of a cogwheel, labrum rupture or irregularities on the cartilage (this form is more serious and can degenerate into hip osteoarthritis).

Most of the patients come to the consultation complaining of a “snap” with the movement of the hip. The location of the snap can be on the outside or at the front of the joint. There are times when they feel like the hip is “subluxed” or has come out. The diagnosis is made with the history, the examination and images. X-rays and MRI will be needed to determine if the cause is inside or outside the hip joint.
Treatment starts with education of the pathology. It is also important to reduce and modify activities to avoid repetitive hip movements. Cold packs can be used when the pain is on the side of the hip. Analgesics are always useful to control the pain. Physiotherapy is particularly useful to stretch and decompress the muscle spasm produced by the pain. This is only useful when the cause of the snapping hip is outside the hip.
If the pain does not subside after a period of 6 months of supervised rehabilitation or in the case that loose bodies are required to be removed, surgery will be indicated. Hip arthroscopy will be offered to release the tendons, remove loose fragments in the joint or fix a torn labrum.