Snapping Hip and Trochanteric Bursitis
Top Contributors - Ewa Jaraczewska, Jess Bell, Kim Jackson, Lucinda hampton and Tarina van der Stockt
Snapping Hip Syndrome (SHS)[edit | edit source]
There are three types of the Snapping Hip syndromes identified: the external , the internal , and the intra-articular snapping hip.
External Snapping Hip[edit | edit source]
External (lateral) snapping hip is a painful condition also known as lateral coxa saltans. It occurs in about 10% of the general population.[1] The external extra-articular factor involves the posterior iliotibial band snapping over the greater trochanter. [2] Second external extra-articular mechanism leading to this condition involves the anterior aspect of the gluteus maximus traveling over the greater trochanter during hip flexion and extension or internal and external rotation of the hip and snapping over the greater trochanter. This may lead to the inflammation of the trochanteric bursa. [2]Individuals with external Snapping Hip syndrome may also have coxa vara, fibrotic scar tissue, a prominent greater trochanter, smaller lateral pelvic width, or a past surgery for anterolateral knee instability.[3][4]
Internal Snapping Hip[edit | edit source]
Internal extra-articular snapping is caused by the iliopsoas tendon flipping over the iliopectinal eminence or the femoral head and often requires hip flexors contraction. Other proposed extra-articular mechanisms of this condition include:
- accessory iliopsoas tendon slips
- iliopsoas snapping over a ridge at the lesser trochanter
- snapping of the iliofemoral ligament over the femoral head
- subluxation of the long head of the biceps at the ischium
- snapping at the anterior inferior iliac spine.[2]
Intra-Articular Snapping Hip[edit | edit source]
The intra-articular factors can lead to development of snapping hip symptom. They include labral tears, ligamentum teres tears, loose bodies such as osteochondral fragments, or joint instability.
Clinically Relevant Anatomy[edit | edit source]
Iliotibial Band[edit | edit source]
The iliotibial band is a thick band of fascia that runs on the lateral side of the thigh from the iliac crest and inserts at the knee.[5] It is composed of dense fibrous connective tissue that originates from the anterior fibres of the tensor fasciae latae and the posterior fibres of the gluteus maximus. After running down on the lateral thigh it ends by most of the fibres inserting onto the tibial tubercle, some inserting into the gluteus maximum tendon, the lateral femoral epicondyle and distal lateral border of the patella. [1]
The iliotibial band role includes hip stabilisation during a single leg stance and ambulation when the band acts as a tendon of the tensor fasciae latae (TFL) and the gluteus maximus. The contraction of the gluteus maximus and the TFL muscles cause the tightening of the band
Gluteus Maximus[edit | edit source]
Gluteus maximus originates at the outer slope of the dorsal segment of the iliac crest, gluteal surface of ilium, dorsal surface of lower part of the sacrum, side of coccyx, and the sacrotuberous ligament. It also shares its attachment to the thoracolumbar fascia with the ipsilateral multifidus and contralateral latissimus dorsi. The muscle inserts onto gluteal tuberosity and the iliotibial band.
The gluteus maximus primary role include hip extension, external rotation and abduction. Its function is essential to maintain an erect posture.
- Essential for maintaining an erect posture
- Lateral rotation of the thigh
- Abduction of the thigh
Mechanism of Injury / Pathological Process
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Clinical Presentation[edit | edit source]
The External Snapping Hip syndrome presents with the sensation describes as feeling of hip dislocation. With the Internal snapping patients describe the feeling of the hip joint being "stuck" or locked and they report hearing sound of snapping. The intermittent sound of clicking or catching characterises the Intra-articular pathology.
Additionally patients report:
- pain
- muscles weakness
- activities limitation[3]
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
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Differential Diagnosis
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Resources
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References[edit | edit source]
- ↑ 1.0 1.1 Randelli F, Mazzoleni MG, Fioruzzi A, Giai Via A, Calvisi V, Ayeni OR. Surgical interventions for external snapping hip syndrome. Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2386-2393.
- ↑ 2.0 2.1 2.2 Yen YM, Lewis CL, Kim YJ. Understanding and Treating the Snapping Hip. Sports Med Arthrosc Rev. 2015 Dec;23(4):194-9.
- ↑ 3.0 3.1 Idjadi J, Meislin R. Symptomatic snapping hip: targeted treatment for maximum pain relief. The Physician and Sportsmedicine 2004;32(1):25-31.
- ↑ Byrd JT. Snapping hip. Operative Techniques in Sports Medicine 2005;13(1):46-54.
- ↑ Baker RL, Fredericson M. Iliotibial Band Syndrome in Runners : Biomechanical Implications and Exercise Interventions. Physical médicine and réhabilitation clinics of North America, 2016; 27(1):53-77
