Snapping Hip Syndrome

Key Points • External coxa saltans is snapping due to the tensor fascia lata and iliotibial band flipping back and forth across the greater trochanter. • Internal coxa saltans is snapping caused by the iliopsoas tendon. • Intra-articular coxa saltans refers to a variety of intra-articular lesions that can cause painful clicking or popping within the joint. • Coxa vara and reduced bi-iliac width have been proposed as predisposing anatomic factors of external coxa soltans. • Symptomatic cases of external coxa saltans are most commonly associated • P.522 • • with repetitive activities, but may occur following trauma. • Snapping of the iliotibial band usually can be demonstrated by the patient better than it can be produced by passive examination. • Radiographs and further investigative studies are rarely of benefit except to assess for other associated disorders. • Surgical intervention rarely is necessary. Published results of a variety of surgical techniques to address recalcitrant snapping of the iliotibial band range from poor to excellent. • Snapping of the iliopsoas tendon can be difficult to differentiate from and may co-exist with intra-articular pathology. • Certain activities, such as ballet, have a tendency to develop snapping of the iliopsoas tendon as an overuse phenomenon. • Endoscopic release of the iliopsoas tendon seems to represent an excellent alternative to traditional open techniques for recalcitrant cases. • When treatment is necessary, most patients will respond to a proper conservative strategy. “Coxa saltans” is a popular term to describe snapping syndromes around the hip, with an external, internal, and intra-articular type described (1). External coxa saltans is snapping due to the tensor fascia lata and iliotibial band flipping back and forth across the greater trochanter. Internal coxa saltans refers to snapping caused by the iliopsoas tendon. Intra-articular coxa saltans is a nonspecific term for a variety of intraarticular lesions that can cause painful clicking or popping emanating from within the joint.