Abstract
Patients with snapping hip syndrome experience a snapping sensation in the lateral hip associated with sudden, sharp pain in the area of the greater trochanter. The snapping sensation and pain are the result of the iliopsoas tendon subluxating over the greater trochanter or iliopectineal eminence. The trochanteric bursa lies between the greater trochanter and the tendon of the gluteus medius muscle and the iliotibial tract. The gluteus medius muscle originates from the outer surface of the ilium, and its fibers pass downward and laterally to attach on the lateral surface of the greater trochanter. The gluteus medius muscle locks the pelvis in place during walking and running; this muscle is innervated by the superior gluteal nerve. The iliopectineal eminence is the point at which the ilium and the pubis bone merge. The psoas and iliacus muscles join at the lateral side of the psoas, and the combined fibers are referred to as the iliopsoas muscle. Like the psoas muscle, the iliacus flexes the thigh on the trunk or, if the thigh is fixed, flexes the trunk on the thigh, such as when moving from a supine to a sitting position.
The symptoms of snapping hip syndrome, which is also known as coxa saltans, occur most commonly when rising from a sitting to a standing position or when walking briskly. Often, trochanteric bursitis coexists with snapping hip syndrome and increases the patient’s pain and disability.
Keywords
snapping hip syndrome, hip pain, iliacus muscle, iliopsoas muscle, iliopsoas tendon, diagnostic sonography, ultrasound guided injection, trochanteric bursitis, coxa sultans
ICD-10 CODE M 65.80
The Clinical Syndrome
Patients with snapping hip syndrome experience a snapping sensation in the lateral hip associated with sudden, sharp pain in the area of the greater trochanter. The snapping sensation and pain are the result of the iliopsoas tendon subluxating over the greater trochanter or iliopectineal eminence ( Fig. 99.1 ). The trochanteric bursa lies between the greater trochanter and the tendon of the gluteus medius muscle and the iliotibial tract. The gluteus medius muscle originates from the outer surface of the ilium, and its fibers pass downward and laterally to attach on the lateral surface of the greater trochanter. The gluteus medius muscle locks the pelvis in place during walking and running; this muscle is innervated by the superior gluteal nerve. The iliopectineal eminence is the point at which the ilium and the pubis bone merge. The psoas and iliacus muscles join at the lateral side of the psoas, and the combined fibers are referred to as the iliopsoas muscle. Like the psoas muscle, the iliacus flexes the thigh on the trunk or, if the thigh is fixed, flexes the trunk on the thigh, such as when moving from a supine to a sitting position.
The symptoms of snapping hip syndrome, which is also known as coxa saltans, occur most commonly when rising from a sitting to a standing position or when walking briskly ( Fig. 99.2 ). Often, trochanteric bursitis coexists with snapping hip syndrome and increases the patient’s pain and disability.
Signs and Symptoms
Physical examination reveals that patients can recreate the snapping and pain by moving from a sitting to a standing position and adducting the hip. This positive snap sign is considered diagnostic for snapping hip syndrome ( Fig. 99.3 ). Point tenderness over the trochanteric bursa, indicative of trochanteric bursitis, is often present.
