Snapping Hip Syndrome Essay

When starting an examination for suspected Snapping Hip Syndrome one should first look and listen for the snap. External there will be visible snapping in the hip while internal usually does not show, but can be felt during palpation. Internal is also more likely to be an audible snapping noise while external is a quieter noise usually not detected. For palpation start at the greater trochanter as the hip is actively flexed. If by applying pressure the snapping stops then it is external Snapping Hip Syndrome. To confirm this diagnosis perform the Ober test looking for tightness in the tensor fascia lata and limited hip adduction when hip is held in extension. If these tests are negative continue the physical examination with passively moving hip from flexed and externally rotated position to an extended and internally rotated position looking to see if snapping
can be reproduced.
Scans that are suggested when predicting Snapping Hip Syndrome are radiographs, ultrasound, MRI, and iliopsoas bursography.
In the article “Snapping Hip (Coxa Saltans)” by Mark Karadesheh and Patrick McCulloch they recommend for radiographs a view of the AP pelvis/hip. This is used to rule-out synovial chondromatosis. For ultrasound, during dynamic movement, snapping of tendons or bands can be viewed for external or internal Snapping Hip Syndrome. For external ultrasound can be used to localize a diagnostic challenge injection into the trochanteric bursa, while for internal the iliopsoas sheath, and the intra-articular space. MRI’s can be used to rule out intra-articular pathology and can show inflamed bursas. Lastly, the use of iliopsoas bursography are to view the iliopsoas tendon under fluoroscopy after the bursa was injected with contrast dye. It is also used for therapeutic injections after diagnosis of Snapping Hip Syndrome is confirmed. These scans are usually only used when there is a suspected intra-articular syndrome or there is thought to be other injuries involved (Mark Karadesheh Reference
6).
Treatments vary between severity of Snapping Hip Syndrome and the type, but there is general treatments that can be done also. Non-operative treatments are usually given for less severe cases. Though sometimes internal and external Snapping Hip Syndrome is painless and does not require treatment for those that do there is two options, activity modification and physical therapy. Activity modifications are used for acute onset for less than six months of painful internal and external. Physical therapy can be combined with a shot of corticosteroid for persistent, painful snapping that interferes with the athlete’s daily living. For more severe cases operative treatments are given which include surgery. Z-plasty of the iliotibial band is used for exertion of the greater trochanteric bursa. This treatment is used when non-operative treatments have failed and there is increasing pain with external hip snapping. This is common after complete hip replacements and done by lengthening the iliotibial band endoscopically with Z-plasty. A treatment used for internal snapping that has failed to recover with non-operative treatments is release of the iliopsoas tendon. There are many approaches with this treatment by approaching from the anterior, medial, ilioinguinal, and iliofemoral aspects. By trying to either partially or completely release the tendon with arthroscope. Post-operative care is very important after this surgery with the patient not being able to do hip flexion strengthening for six weeks. The last common operative treatment is for intra-articular snapping with hip arthroscopy to remove loose bodies or labral debridement. This is only done when non-operative treatments have failed and an MRI has confirmed loose bodies or labral tears (Reference 6). Though there are many more options for non-operative and operative treatments these are just a few of the most common.
Athletic trainers have an important job of doing clinical diagnosis. Though Snapping Hip Syndrome is mostly common in dancers and cyclists it does appear in runners and gymnasts. When performing examinations it is important to use your senses to both feel and listen for popping when palpating and extending the hip. The athlete might consider it a normal feeling when there is no pain associated with the snapping and may not tell the athletic trainer in an evaluation. Basic strengthening rehabilitation can be given to strengthen the tendons and muscles surrounding the hip and upper thigh to decrease chances of the snapping hindering the athlete’s performance and everyday life.
Though mostly seen in dancers Snapping Hip Syndrome is common in cyclists, runners, and gymnast. There is three different types of the syndrome broken into external, internal, and intra-articular with all affecting different areas of the muscles and tendons surrounding the hip. Many aspects of Snapping Hip Syndrome is subjective to the athlete like pain and sound. Though there is few clinical experiments as treating this syndrome as a whole there are general treatments that can be done though some are better for different sports and the different variations of the syndrome. It is the athletic trainers’ job to be looking for Snapping Hip Syndrome when doing evaluations on the hip and ask athletes if they are experiencing “snapping” in the sports that are most common to acquire this injury.