Ortho Dx: Snapping hip - Clinical Advisor

Ortho Dx: Snapping hip

Slideshow

  • Anteroposterior radiograph of the left hip of a 23-year-old man diagnosed with snapping hip shows no abnormalities.

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    Anteroposterior radiograph of the left hip of a 23-year-old man diagnosed with snapping hip shows no abnormalities.

  • Lateral radiograph of the patient.

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    Lateral radiograph of the patient.

A 23-year-old man presents with a “snapping” sensation over the anterior left hip during activities. The sensation often occurs when he runs and is more “annoying” than painful. Anteroposterior and lateral radiographs of his left hip taken in the office are negative for abnormalities. He is diagnosed with snapping hip.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

 

Snapping of the hip, or coxa saltans, is a snapping or popping sensation in the hip that occurs with physical activity. The snapping sensation can be caused by muscles or tendons moving over bony structures of the hip. The causes...

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Snapping of the hip, or coxa saltans, is a snapping or popping sensation in the hip that occurs with physical activity. The snapping sensation can be caused by muscles or tendons moving over bony structures of the hip.

The causes are divided into 3 main types: external, internal, and intra-articular. Externally caused snapping occurs when the iliotibial band slides over the greater trochanter of the proximal femur. During hip flexion, the taut iliotibial band slides anterior to the prominent trochanter, which may result in underlying bursitis. The internal type—the most common form—is thought to be caused by the iliopsoas tendon snapping over the anterior hip during hip flexion and extension. The intra-articular type can be caused by an intra-articular loose body or tear of the acetabular labrum.1,2

Patients will often point to the location of the hip snapping when the hip is taken through range of motion. A positive Ober test and palpable snapping over the greater trochanter during hip flexion points to an external type snapping hip. Snapping of the iliopsoas can often be reproduced by moving the hip from flexion and external rotation to extension and internal rotation. A painful clicking or locking in the groin during hip motion is more likely an intra-articular type.

Externally caused and internally caused snapping hip may be treated conservatively with activity modification, nonsteroidal anti-inflammatory drugs, physical therapy, and targeted steroid injections.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

Reference

  1. Allen WC, Cope R. Coxa saltans. The snapping hip revisited. J Am Acad Orthop Surg. 1995;3:303-308.
  2. Karadsheh M, McCulloch P. Snapping Hip (Coxa Saltans). http://www.orthobullets.com/sports/3096/snapping-hip-coxa-saltans. Accessed January 23, 2017.  

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