Snapping Hip Syndrome Clinical Presentation

Updated: Aug 30, 2017
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Craig C Young, MD  more...
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Presentation

History

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  • The location may be described as lateral (indicating the iliotibial band or gluteus maximus) or anterior and deep in the groin (indicating the iliopsoas tendon).

  • Often the sensation of the hip subluxing or dislocating is described and is associated with the iliotibial band or external snapping hip. This can be quite a dramatic presentation and accounts for the description that external snapping hip is the condition that you "see".

  • Individuals with internal snapping hip present with reports of an audible snap or click in the hip, which may be either painless or painful. The audible snap is due to the snapping of the iliopsoas tendon and accounts for the description that iliopsoas snapping hip is the condition that you "hear".

  • Patients reporting anterior groin pain usually note that the pain is dull or aching in nature and is exacerbated by extension of the flexed, abducted, and externally rotated hip.

  • The pain and snapping may subside with decreased activity and rest.

  • The duration of symptoms at presentation more commonly is several months or years rather than days or weeks.

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Physical

An individual with hip pain should undergo a careful examination of the abdomen, pelvis, groin, and thigh. Additionally, consider a gynecologic examination for women presenting with groin pain.

Inspection

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  • Examine the gait for abnormalities in biomechanics.

  • If associated iliopsoas tendinitis is present, the patient may have a flexed knee in the heel-strike and midstance phases of gait.

  • Observe reproduction of the snapping.

  • External snapping hip syndrome associated with subluxation of the iliotibial band over the greater trochanter may be dramatic and appear as if the patient is subluxing their hip.

Palpation

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  • Those with external snapping hip syndrome may have tenderness over the proximal iliotibial band, lateral margin of the gluteus maximus, or trochanteric bursa.

  • Those with internal snapping hip syndrome associated with a tight iliopsoas tendon may demonstrate an anterior pelvic tilt with resulting hamstring inflexibility. Snapping occurs with extension of the flexed, abducted, and externally rotated hip. Tenderness may be elicited in the femoral triangle, and the actual snapping is often palpable in conjunction with the audible snap.

Functional testing

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  • External snapping hip syndrome symptoms can often be reproduced with passive internal and external rotation of the hip with the patient in the side-lying position.

  • Internal snapping hip syndrome symptoms (i.e. snapping and associated pain, if present) can be reproduced with extension of the flexed (30°), abducted, and externally rotated hip. The authors have also noted that active movement of the affected hip from a neutral position to one of flexion, abduction, and external rotation may also reproduce the snapping. Additionally, if the patient has associated iliopsoas tendinitis, resisted hip flexion at 15° with the patient seated and the knee extended, palpation of the psoas muscle just below the lateral half of the inguinal ligament reproduces the pain, if not the snapping.

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Causes

Snapping hip syndrome has been attributed to multiple mechanisms associated with the skeletal architecture of the hip and pelvis and with the muscles, tendons, and ligaments around the hip. Snapping hip has been described according to the location of the mechanism as external, internal, or posterior. Despite the many descriptions of possible mechanisms, the most common causes of snapping hip syndrome include either subluxation of the iliotibial band over the greater trochanter or sudden movement of the iliopsoas tendon over the iliopectineal eminence.

  • External snapping hip syndrome is primarily caused by subluxation of the iliotibial band over the greater trochanter of the femur. It has also been described as a snapping of the outer border of the gluteus maximus over the greater trochanter. [7] Eccentric hip abduction strength has been described in individuals with external snapping hip and may be a contributing factor, though a clear causal relationship has not been determined. [3]

  • Internal snapping hip syndrome occurs by one of several mechanisms.

    • The most common cause is believed to be the iliopsoas tendon sliding over the iliopectineal eminence, resulting in an audible "snap" or "pop". This typically occurs while the hip suddenly moves into extension from a flexed and externally rotated position.

    • The iliopsoas tendon also may produce snapping with sudden movement over the anterior inferior iliac spine or possibly the bony ridge on the lesser trochanter.

    • Less common causes of internal snapping hip syndrome include movement of the iliofemoral ligaments over the femoral head or anterior capsule of the hip. [8]

  • Posterior snapping hip syndrome is uncommon and is caused by movement of the long head tendon of the biceps femoris over the ischial tuberosity.

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