Snapping or Clicking Hip Syndrome (SHS): Lesser known but Important

What is Snapping Hip Syndrome?

When the hip is moving, there may be an audible "snap" or "click" sound in or around the hip, which is a symptom of the condition known as snapping hip syndrome (SHS), also known as Coxa Saltans. 

Causes

SHS can have a number of different causes, which are further divided into three categories: intra-articular, internal, and external.

External: The iliotibial band crossing the greater trochanter of the femur externally is the most frequent occurrence.

Internal: The iliopsoas tendon snapping over a bony prominence of the pelvis.

Intra-articular (least frequent)

Signs & Symptoms

External SHS:

A snapping or pain that is localized laterally over the greater trochanter typically develops gradually in people with external SHS. The external type mostly involves a minor mechanism of injury and is not connected to a traumatic event. 

Frequently, the clinical presentation can be seen by watching and listening for a snap as the patient actively flexes and extends the hip. Some of these patients may say they feel like their hip is dislocating. Additional conditions associated with external SHS include coxa vara, fibrotic scar tissue, a prominent greater trochanter, a smaller lateral pelvic width, and a history of surgery for anterolateral knee instability.

Internal SHS:

Internal SHS also develops gradually and is typically not brought on by a traumatic event. As they move their hip from flexion to extension or external rotation, these patients report a sharp pain emanating from deep within the anterior groin. The movement of the snapping can cause an audible clunk or click.

Intra-articular SHS:

Intra-articular SHS patients describe a sudden onset of snapping or clicking following a trauma or injury to the hip capsule. A torn acetabular labrum, synovial chondromatosis, intracapsular lesions, loose bodies accumulating in the acetabular fovea or synovial folds, a history of habitual hip dislocation in children, or idiopathic recurrent subluxation can all be causes of this snapping.

Conservative treatment

Referred to as the initial and preferred course of treatment, and frequently includes techniques for managing common types of tendinitis. includes ice, rest, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid or lidocaine injections, and physical therapy frequently.

Surgical treatment

Surgical intervention for snapping hip syndrome (SHS) should only be considered as a last resort if conservative treatments have failed to improve symptoms. The main goal of surgery is to lengthen or relax the tight tendon or ligament causing the snapping sensation and also to address any underlying contributing pathologies that are commonly associated with SHS.

There is some debate among researchers regarding the best type of surgical procedure for each type of SHS classification. However, most agree that arthroscopic surgery generally results in better outcomes and fewer complications than traditional open surgery.

Physiotherapy Management

As SHS is a syndrome, one physical treatment can not be effective. A therapist has to come up with a treatment plan as per the individual patient's condition and need.

Stretching of anterior hip structures or Iliotibial band, as these structures undergo tightness.

Eccentric strengthening exercises can be helpful when it comes to physiotherapy management.

Myofascial release of tensor fascia latae, adductor, gluteus medius, and gluteus maximus to relieve the pain, especially in the case of lateral snapping of the hip.

Avoid damaging motions at the hip joint. Once the hip joint is able to sustain the load, range of motion exercises can be performed.