Boyd W. Haynes III, MD
Have you ever experienced a snapping sound and/or sensation when you walk? This commonly seen condition is called Snapping Hip Syndrome, and it involves an issue with movement either inside or outside of the hip joint. While initially harmless and painless (and maybe an often trotted-out party-trick, “Hey Jim, make your hip pop!”) this continued “snapping” of the tendon or joint can eventually lead to pain, joint deterioration and dysfunction. In this article, I will discuss the three types of Snapping Hip Syndrome, the symptoms and how they are treated.
External snapping – a tendon or muscle, the gluteus maximus or iliotibial band, slides over the top of the femur, gets temporarily impeded when it moves over the boney prominence, is pulled taut and then “snaps” free. Snapping may occur when running, climbing stairs or carrying heavy loads. As it progresses, a sharp pain may be felt on the outside of the hip, which worsens with activity. Patients often report that their hip feels like it is coming out of the socket. Trochantic bursitis often accompanies this form of snapping hip.
Internal snapping – This is the most common form of snapping hip, where a tendon or muscle, the iliopsoas tendon or the quadriceps (hip flexors), slides over the pelvic bone or hip joint, is pulled taut and then “snaps” free. The hip typically snaps when arising from a sitting position, when running, or when the hip rotates the leg away from the body. The onset of symptoms is gradual, but can progress to a sharp pain in the front of the hip, deep in the groin, which can worsen with activity. It is often accompanied by iliopsoas hip bursitis.
Intra-articular snapping – this is the least common type of snapping hip where the actual hip joint has a mechanical issue that causes it to catch. There are three main causes, which are 1) a torn labrum in the hip; 2) loose fragment(s) of bone or tissue inside the joint; 3) injury to the cartilage inside the hip joint. Patients may experience a gradual onset of symptoms or immediately after trauma.
To diagnose snapping hip syndrome and which type, I ask the patient many questions about onset, what activity causes the snapping, and what home remedies that they may have tried. I will ask the patient to show me what movements make their hip snap. I order x-rays, not to confirm snapping hip syndrome, but they will show me if any tumors, bone spurs or arthritis are in the hip joint. I always start with conservative treatment, which will include rest, activity modification, Physical Therapy and the use of NSAIDS. For patients who are experiencing bursitis, I may recommend oral or injected steroids. It may take 6-12 months to experience full symptom relief and the patient must continue at home PT exercises if they don’t want symptoms to return.
If the patient doesn’t improve, I may order an MRI to get a better idea of what is happening inside the joint and in all of the soft tissues surrounding the joint. In some cases, surgery will be required to correct the problem. The offending tendons can be surgically released to provide pain relief. In the case of a torn hip labrum, that must be surgically repaired and the labrum anchored. In the case of loose fragments within the hip joint, these can be removed via arthroscopic surgery. All of these surgeries will be done on an outpatient basis and the patient will be released to recover at home, barring any complications.
Recovery from surgery for snapping hip syndrome will vary depending upon what type of surgery was performed. Simple removal of debris from the hip joint may see you back to normal activities in a few weeks. Recovering from a labral repair may take four to six months. You may or may not be given crutches to use while healing. Rest and gradually increasing physical activity will be important. Physical Therapy will be recommended to help you regain strength and function.
Thankfully, most cases of snapping hip syndrome can be resolved non-surgically. If you notice your hip is audibly snapping during activity, listen and heed the warning. Make an appointment with an Orthopaedic specialist BEFORE the pain starts and you can stop the more severe symptoms from happening.