Snapping Hip

Causes

 

Most common

- fascia lata on greater trochanter

- iliopsoas on lesser trochanter

 

1.  Intra-articular structures

- labrum

- ligamentum Teres

- loose bodies

- synovial chondromatosis

- osteochondoma

 

2.  Extra-articular structures

- fascia lata on greater trochanter (common) 

- iliopsoas on lesser trochanter / iliopectineal eminence 

- long head biceps femoris over ischial tuberosity

- iliofemoral ligament over femoral head

 

Iliotibial Band over GT

 

Symptoms

 

Usually painless

Can often be produced voluntarily

 

Examination

 

Hip flexion and internal rotation causes readily palpable snapping sensation

- tight iliotibial band subluxates over the greater trochanter

 

Management

 

Majority of patients no treatment required

- rest

- iliotibial band stretching exercises

- NSAIDS +/- local corticosteroid injections

 

Surgery

- rare persistent cases 

- elliptical resection of the iliotibial band over the greater trochanter + greater trochanteric bursectomy 

 

Iliopsoas Tendon

 

Symptoms

- snapping sensation felt in the groin as the hip is extended from a flexed position

- palpated as the supine patient extends the hip from a position of flexion / abduction & external rotation

 

Management

 

Non operative as above

 

Surgery

- resistant cases

- psoas lengthening

- resection prominence of lesser trochanter

- psoas division (can be done arthroscopically)