Clinical findings:
(1) A painful and/or audible snap in the hip is heard while running, with the hip is flexed, abducted and externally rotated, then extended.
(2) Symptoms are reported lateral to the greater trochanter or anterior to the hip.
(3) Normal CT and MRI studies.
Types: external or internal
Causes of external snapping hip:
(1) movement of a thickened iliotibial band over the greater trochanter
(2) movement of the gluteus maximus tendon over the greater trochanter
(3) movement of the tensor fasciae latae over the greater trochanter
Causes of internal snapping hip:
(1) iliopsoas tendon passing over the anterior hip capsule, lessor trochanter, femoral head or iliopectineal eminence
(2) biceps femoris passing over the ischial tuberosity
(3) iliofemoral ligament passing over the femoral head
(4) iliopsoas bursitis
(5) acetabular labral tear
(6) recurrent hip subluxation
(7) osteochondral fracture
(8) intra-articular loose body
Features of the external type:
(1) The symptoms are reported lateral to the greater trochanter.
(2) Snapping of the external type may be reproduced by moving the hip from flexion to extension.
Features of the external type:
(1) The symptoms are reported anterior to the hip.
(2) Snapping of the internal type may be reproduced by extending and internally rotating a flexed, abducted and externally rotated hip.
Management:
(1) relative rest
(2) analgesia
(3) stretching of the iliotibial band
(4) regional muscle strengthening
(5) correcting any biomechanical problems
(6) occasionally corticosteroid injections
(7) rarely surgical correction
