Snapping Hip Syndrome (Painless Hip Clicking)

The causes of snapping hip syndrome include:

• Difference in leg lengths

  Snapping hip syndrome is commonly associated with leg length difference or anisomelia (usually the long side is symptomatic) due to chronic tightness in the muscles and around the hip.

• Ligament laxity (loose ligament)

  Due to repetitive use or traumatic incident, connective tissues like ligaments become lax or loose. Loose ligaments can lead to snapping hip syndrome.

• Prolonged physical activities

  Prolonged activities requiring repetitive hip flexion and extension, such as soccer, gymnastics, dancing and running, may lead to snapping hip syndrome.

• Repetitive hip movements

  With repetitive use and age, the cartilage in the hips can get damaged. Repetitive hip movements in activities such as running or dancing can cause the cartilage to be overused, leading to snapping hip syndrome.

• Tight iliotibial band

  The iliotibial band is a large tendon that runs along the outside of the thigh. If the tendon is tight, it can create a snapping sensation which will gradually worsens and may become painful if not treated.

• Weakness in the muscles around the hip

  Weakness in the gluteus medius, a large fan-shaped muscle located in the posterior hip, extending from the ilium to the proximal femur may cause snapping hip syndrome.

Risk factors for snapping hip syndrome

Factors that put you at risk for developing snapping hip syndrome include:

• Participation in activities requiring the extremes of hip motion such as ballet dancing, football, soccer

• Participation in competitive and recreational activities such as weightlifting and running

• Physical trauma – Patients who had a traumatic injury to the hip joint

Preventing snapping hip syndrome

Though it is not always possible to prevent this condition, there are a few things you can do to lessen your chances of developing snapping hip syndrome.

• Perform warm-up exercises before participating in a sport or any heavy physical activity. Make sure to include stretches for the hip muscles.

• Avoid abruptly involving yourself in physical activities. If you need to participate in sports or other activities, start gradually and slowly increase in intensity.

• Maintain good physical condition by consistently following a strength and flexibility work-out program.

• Always wear comfortable shoes that fit you properly.

Patients with snapping hip syndrome usually experience a snapping and locking sensation in the hip, and they hear a popping sound coming from the affected hip as they move.

The following are the more specific symptoms of snapping hip syndrome:

• A snapping sound
• Noise around the hip joint when bending or extending your hip
• Pain that eases with rest and reduced activities
• Weakness in your leg when you try to lift it or move it sideways
• Tightness in the hip
• Swelling in the front, back or side of your hip
• Difficulty when doing daily activities like walking or standing up from a chair

To determine if you have snapping hip syndrome, your doctor will perform a physical examination and check your medical history. In some cases, imaging tests may also be necessary to further investigate your condition.

Physical exam and medical history

Your doctor will ask about your symptoms and other information such as the location of the snap, timing of the snap, duration, pain, and impact on your daily activities. The exam may include basic tests such as palpation of the affected area, Hip ROM, Muscle length tests, and Hula-hoop test.

X-ray

X-ray is a diagnostic procedure that uses small amounts of radiation to create a picture of your spine. Radiography is used both to confirm the snapping hip syndrome and rule out any underlying conditions.

Ultrasound

If physical exam cannot detect the syndrome, your doctor may recommend a dynamic ultrasonography to show the snapping of the iliotibial band over the greater trochanter. Dynamic ultrasound test can also detect associated health problems like tendonitis, iliopsoas bursitis or muscle tears.

Iliopsoas bursography

This diagnostic procedure is used to visualise iliopsoas tendon under fluoroscopy after contrast dye is injected into the bursa, a fluid-filled sac that reduces friction between moving tissues.

Magnetic resonance imaging (MRI scan)

MRI can be used to rule out intra-articular causes. It is often done as an arthrogram study to show inflamed bursa.

Snapping hip syndrome is often painless and may not require medical treatment. If it causes minor pain or discomfort, your doctor may recommend pain relievers and a cold compress. You are required to limit physical activity to give your muscles and tendons time to heal.

In more serious cases, medical treatments such as physical therapy, pain medication or surgery may be necessary.

Treatment for snapping hip syndrome usually includes:

Non-surgical treatments

• Applying ice or cold compress on the affected area to reduce swelling
• Non-steroidal anti-inflammatory drugs
• Reducing activity levels
• Exercises to strengthen and stretch surrounding muscles

Surgical treatments

Rarely, surgery may be necessary to relieve symptoms of snapping hip syndrome. Depending on the underlying cause of the condition, treatment options may include:

• Iliotibial band release – lengthening the iliotibial band to decrease tension and hip snapping
• Iliopsoas tendon release – lengthening the iliopsoas tendon to lessen muscle tension and reduce hip clicking
• Arthroscopic hip debridement – involves making a small incision at the hip joint cavity to take away debris

Consult a specialist to determine the treatment method most suitable for you. At Mount Elizabeth Hospitals, our experienced orthopaedic consultants and surgeons are supported by a comprehensive team of nurses and physiotherapists to provide you with the suitable treatment options.

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While snapping hip syndrome is not a life-threatening condition, it can lead to complications in the long run, especially if left untreated. The complications may include:

• Persistent hip pain

  Untreated snapping hip symptoms can progress and lead to intense discomfort.

• Painful bursa or hip bursitis

  The most common causes of snapping hip syndrome include iliotibial band syndrome, which can lead to an irritated bursa or potential hip bursitis.

• Iliopsoas tendon snap

  Although iliopsoas tendon snap may not cause physical pain or limit mobility, the snapping sensation can disrupt your daily routines and activities.