Snapping hip syndrome

Overview

Snapping hip syndrome (SHS), also known as coxa saltans, is a condition characterized by an audible snapping or popping sensation in the hip during movement, particularly during activities involving hip flexion and extension. While the snapping sound is often painless and harmless in many individuals, it can be associated with pain, discomfort, or functional limitations in others, especially athletes and dancers.

Snapping hip syndrome is generally classified into three types: external, internal, and intra-articular, depending on the anatomical structures involved. Understanding the type and underlying cause is essential for proper treatment and long-term management of the condition.

Causes

The causes of snapping hip syndrome differ based on its classification:

1. External Snapping Hip

• Caused by the iliotibial band or gluteus maximus tendon snapping over the greater trochanter of the femur.

• Common in runners, dancers, and athletes who perform repetitive hip movements.

2. Internal Snapping Hip

• Occurs when the iliopsoas tendon slides over structures such as the iliopectineal eminence or femoral head.

• Often associated with tight hip flexors and may be triggered by activities involving hip extension from a flexed position.

3. Intra-articular Snapping Hip

• Caused by problems within the hip joint, such as labral tears, loose bodies, or cartilage damage.

• May be associated with underlying hip joint pathology or trauma.

Symptoms

The hallmark symptom of snapping hip syndrome is a snapping or popping sensation in the hip, but other symptoms may vary based on the type:

• Audible snapping sound during hip movement (e.g., walking, rising from a chair, or swinging the leg)

• Sensation of the hip "catching" or "popping out"

• Hip pain or discomfort, especially after prolonged activity

• Swelling or inflammation in cases with associated bursitis

• Limited range of motion or stiffness in more severe or chronic cases

Intra-articular SHS may present with deeper hip pain and symptoms similar to those seen in other intra-articular pathologies.

Diagnosis

Diagnosis of snapping hip syndrome typically involves a combination of physical examination and imaging studies:

• Clinical evaluation: A detailed history of the symptoms, physical activity, and physical examination maneuvers that reproduce the snapping sound.

• Dynamic assessment: Observation of hip movement during specific motions such as flexion and extension, abduction, and rotation to identify the source of snapping.

• Imaging studies:

  • Ultrasound: Real-time imaging can confirm tendon movement and snapping over bony structures.

  • MRI: Useful to evaluate intra-articular causes, such as labral tears or synovial abnormalities.

  • X-ray: May be used to rule out bone abnormalities or joint pathology.

Intra-articular causes may require more advanced imaging or arthroscopic evaluation for confirmation.

Treatment

Treatment of snapping hip syndrome depends on the severity of symptoms and the underlying cause. Most cases respond well to conservative, non-surgical measures:

Conservative Treatment

• Activity modification: Avoiding repetitive hip movements that trigger snapping.

• Physical therapy: Focused on stretching and strengthening the hip flexors, abductors, and rotators to relieve tension on involved tendons.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.

• Icing and rest: Especially useful in cases of acute pain or inflammation.

Medical and Surgical Options

• Corticosteroid injections: Used in cases involving trochanteric bursitis or significant pain.

• Needle tenotomy or dry needling: Minimally invasive procedures to relieve tendon tension.

• Surgical intervention: Reserved for persistent or severe cases. Procedures may include:

  • Iliopsoas tendon release

  • IT band lengthening

  • Hip arthroscopy for intra-articular pathology

Prognosis

The prognosis for snapping hip syndrome is generally excellent with proper treatment. Most individuals experience significant relief from symptoms with conservative management, especially when addressed early. Athletes and active individuals can often return to full activity after completing a tailored rehabilitation program.

For those who require surgery, outcomes are typically positive, although recovery times vary depending on the procedure. Preventing recurrence through continued stretching, strengthening, and proper biomechanics is essential for long-term success.