The so-called snapping hip is a pathology that is characterized by sensation of a snap or a protrusion, in the groin, or in the hip region.
Dr. Manuel Villanuevatraumatologist and medical director of Avanfi explains: «The clicking can occur in forced positions or simply when getting up from a chair, bending over or walking. The highlight can be heardalthough it is not common, and it can alter your progress. Fortunately, in 70% of cases it does not bother or bothers very little, but in some patients it can be very painful.
It mainly affects young women (15-40 years old) and athletes. when a tendon or muscle slides over a bony prominence. The snap It occurs due to the friction or jumping of a tendon or a structure on a bony prominence. The patient may have the sensation that his hip is coming out of place when making certain movements, although the joint is not coming out.
Types of hip spring
There are, as the specialist clarifies, two types of snapping hip:
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- Intra-articular spring hip: It appears due to the presence of a free body inside the joint that causes a joint blockage, due to an injury to the labrum (like the meniscus of the knee, but in the hip), to the round ligament (ligament that joins the head of the femur to the pelvis), an injury to the cartilage of the joint or a disease of the synovium or any cause that causes the joint to rub or become blocked. This type of hip snap can cause, due to poor joint function, accelerated wear and tear and is usually painful. Fortunately, it is not that common. If the patient is young and there is no advanced osteoarthritis, hip arthroscopy can solve some of these problems.
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- Hip in extra-articular spring: This, in turn, can be:
– External or lateral: It is caused by the friction of the iliotibial band (due to increased tension, thickening) on the greater trochanter, which causes a clicking sound.
Some of the causes that favor thickening of the tensor fasciae latae are: weakness in the abductors, uneven leg length, or long-distance running.
“Lateral snapping hip is the most common form of snapping hip, although, fortunately, it is usually painless or very minor,” says Dr. Villanueva.
-Internal: This type is caused by the sliding of the iliopsoas tendon on the iliopectineal eminence of the pelvis or the head of the femur.
-Later: Caused by the protrusion of the hamstring muscles (long head of the biceps) on the ischial tuberosity.
The causes or predisposing factors
For Dr. Villanueva, “among the predisposing causes, intrinsic factors have been postulated: retracted tibial band, knee in valgus (in X), or in varus (in arch), excess internal rotation of the tibia or pronation of the foot, hip abductor weakness and limb length differences. While the extrinsic factors are: overtraining or on hard and uneven ground, inappropriate footwear.
And he insists: «A stiff joint, due to osteoarthritis, dysplasia or malformation of the joint, femoroacetabular impingement (an alteration in the shape and development of the hip that favors impingement between the femur and the acetabulum, the pelvis), gluteal fibrosis, or on the contrary, hypermobility, are alterations that can favor a hip in spring.
«It is also known that the cause of hip snapping can be multifactorial. It is thought that the problem frequently begins in the hip abductor muscles, the gluteus or the tensor fascia lata itself, which due to weakness or fatigue do not stabilize the pelvis. Or a deformity of the foot or knee can cause an ascending chain of injury that ends up irritating the band in the hip area and creating a protrusion,” he adds.
Diagnosis
Generally the patient is able to reproduce the symptoms. The exploration with rotation testflexion, extension of the leg, etc., in combination with ultrasound, x-rays, MRI or arthro-MRI (MRI with contrast) will allow us to distinguish if there is any malformation, any damaged structure in the joint itself or, on the contrary, , the problem is outside the joint.
The hip in lateral spring It can usually be reproduced with squatting or squatting maneuvers or, with flexion-extension and rotation movements of the hip with the patient lying on his side on the table. The Ober test is also significant, an excess of tension that prevents the patient, in this side position and with the knee flexed, from bringing the leg closer affects the other.
The treatment
The treatment depends on the degree of discomfort it produces and the type of spring hip. When snapping hips are painless, there is no need to treat them.
In some of the mild intra-articular lesions, ultrasound-guided infiltrations can be performed, selectively, with corticosteroidshyaluronic acid or other therapies from the patient’s blood. In younger patients and with very symptomatic labral tears or femoroacetabular impingement, hip arthroscopy may be necessary.
In extra-articular injuries, which are more common, generally, “the primary treatment of choice will be conservative, including physiotherapymodifying sports activities and performing gluteal and tensor fascia lata strengthening exercises, combined with stretching. Along with this, other muscle groups will be worked: rectus femoris and psoas, hip adductors, short rotators and piriformis, to correct the imbalance between the hip and knee muscles,” recalls the director of Avanfi.
Ultrasound-guided surgery, unopened
If conservative treatment fails, surgical treatment is indicated. For the external spring hip, a partial or total resection of the iliotibial tract can be performedon the greater trochanter, attached or not, in selected cases, to the release of the band in the distal area, on the knee, as an associated procedure.
Dr Villanueva is a pioneer of snap hip release surgery and iliotibial band with ultrasound-guided surgeryboth published techniques, indexed in Pubmed and in the AAOS.
«This is done with local anesthesia, with 1-2 mm incisions, the patient moves the leg actively (they only have local anesthesia) instantly verifying that the problem has been resolved. The same occurs with the distal release of the iliotibial band in cases of runner’s syndrome. TOfortunately, most patientsor are in enough pain to need this surgeryno matter how advanced and minimally invasive it may be, but it is always good to explain to them that, if necessary, they have that solution, walking out instantly and without scars (remember that the majority are young women) and walking out immediately after the surgery,” concludes.
