Snapping Hip Syndrome

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Mechanism of Injury

Snapping noises in the regon of the hip joint is a relatively common clinical presentation. The most common cause is the slipping of the iliotibial band (a thick fibrous band that runs down the side of the leg) over the greater trochanter bone of the hip. During walking and running the iliotibial band is under tension as it slides over the greater trochanter bone. If the tension increases then it usually manifests itself with a 'snap' rather than a slide. The pain is due to the inflammation of the iliotibial band and the trochnateric bursa which is a sack that fills with fluid if excess friction is placed on the area.

Sports

Can occur in a number of activities but mainly running sports and dancing

Incidence

• 10-25 years
• More common in females due to wider pelvic bones causing an increased Q-angle (the angle of the thigh bone meeting the knee)

Pathology

Intra articular causes (quite rare):

• Subluxation (mild dislocation) of the hip
• Loose bodies in the hip joint
• Synovial Chrondomatosis (hip joint lining increasing in thickness with calcific nodules)

Extra articular causes:

Poor Core Stability
Weak Gluteal (Buttock) Muscles 
Tight Hip Flexor Muscles
• Tight Adductor Muscles
• Poor Lower Limb Biomechanics

Symptoms:

• Pain may or may not be present. Usually occurs in the buttock region and radiates down the lateral side of the thigh.

Signs:

• Snapping sensation in the side of the hip on weight bearing movement between hip flexion and extension
• Tenderness on palpation of the Greater Trochanter (Hip Bone)

Investigations

The following investigations will be useful to determine the diagnosis:

• MRI to look for inflammatory signals and rule out other hip pathology
• CT Scans (to check for bone issues)
• X-ray
• Ultrasound to look at the tendons in real time

Treatment

Conservative

• Rest from aggravating activity – total or relative
• Ice
• NSAIDS (Non Steroidal Anti-inflammatory Drugs – Ibuprofen up to Voltarol)
• Stretching to Adductors, Quadriceps, Hip Flexors, Hamstrings
• Hold/Relax Stretching to Hip Flexors
• Deep Frictions
• Ultrasound
• Strengthening exercises to Gluteal Muscles(without pain)
• Core stability exercises
• Steroid injections around the Trochanteric Bursa and Iliotibial Band
• Podiatry Assessment for Lower Limb Biomechanics

Surgery

Is only really contemplated if conservative treatment fails. The surgical options include excision of the Trochanteric Bursa and splitting of the Iliotibial Band to reintroduce a sliding over the Greater Trochanter.