Snapping hip syndrome

1. Snapping Hip/Coxa Sultans

3. • Snapping hip is a condition characterized by audible snapping usually
seen with flexion and extension of the hip.

4. Types of snapping hip
• Extra Articular-
• External and internal
• Intra articular

5. External type
• MC type
• Seen in athletics,soccer players and ballet dancers
• Snapping of IT band, Gluteus maximus and TFL over GT

8. Etiopathogenesis
• Increased tension in already taut IT band with repeated flexion and
extension
• Increased friction at GT
• Trochanteric bursitis and IT band fibrosis
• Snapping of IT over GT

9. Causes of increased tension in IT band
• Flexion and extension of hip
• Femoral anteversion and retroversion
• Internal tibial torsion
• Weakness of hip abductors
Post THR-Curved stem
Angulation
Femoral component placed too far

10. Clinical presentation
• Snapping sensations a/w discomfort
• Examination in RT and Lt lateral decubitus position by
applyingpressure to GT.

11. Investigations
• 1)X-ray
• 2)MRI-Thickening of IT band,Gluteus maximus

12. Internal Coxa sultans
• Snapping of iliopsoas over head of femur,iliopectineus and KT.
• Seen in rowers(Strong iliopsoas)

14. Etiology
• 1) Exostosis of iliopectineal ridge
• 2) Exostosis of LT

15. Clinical presentation
• Snapping a/w discomfort
• Examination
• Supine position with hip actively flexed and examiner palpates over
head of femur

16. Investigations
• 1)X-ray
• 2) MRI-Thickening of iliopsoas

17. Intra articular Coxa sultans
• Etiology
• 1)Labral tears
• 2)Loose bodies
• 3)Synovial chondromatosis

18. Pathogenesis
• Loose bodies lodge into foveal area of acetabulum causing snapping

19. Clinical presentation
• H/o trauma
• Pain,snapping.

20. Investigations
• 1)X-ray
• 2)MRI-Labral tears and loose bodies

21. Management
Conservative
Rest
Avoidance of activities
Stretching and strengthening-Quadriceps strengthening, hamstring
strengthening,Hip abductor and adductor strengthening,Gluteus
maximus and piriformis strengthening
CCT-Cold compression therapy
BFST-Blood flow stimulation therapy

23. Operative
• 1) External-Z plasty of IT band with excision of trochanteric bursa
• 2)Internal-Lengthening of iliopsoas tendinous part
• 3)Intra articular-Arthroscopic removal of loose bodies,labral tear.

24. • Thank you