Snapping Hip Syndrome Clinical Presentation

Updated: Nov 16, 2022
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Craig C Young, MD  more...
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Presentation

History

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.

Next:

Physical Examination

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

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

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

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 (ie, 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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