Snapping Hip Research Articles

Rehabilitation Exercise Progression for the Gluteus Medius Muscle with Consideration for Iliopsoas Tendinitis

Background It is common for hip arthroscopy patients to demonstrate significant gluteus medius muscle weakness and concurrent iliopsoas tendinitis. Restoration of gluteus medius muscle function is essential for normal hip function. Hypothesis A progression of hip rehabilitation exercises to strengthen the gluteus medius muscle could be identified that minimize concurrent iliopsoas muscle activation to reduce the risk of developing or aggravating hip flexor tendinitis Study Design Descriptive laboratory study. Methods Electromyography (EMG) signals of the gluteus medius and iliopsoas muscles were recorded from 10 healthy participants during 13 hip rehabilitation exercises. The indwelling fine-wire EMG electrodes were inserted under ultrasound guidance. The average and peak EMG amplitudes, normalized by the peak EMG amplitude elicited during maximum voluntary contractions, were determined and rank-ordered from low to high. The ratio of iliopsoas to gluteus medius muscle activity was calculated for each exercise. Exercises were placed into respective time phases based on average gluteus medius EMG amplitude, except that exercises involving hip rotation were avoided in phase I (phase I, initial 4 or 8 weeks; phase II, subsequent 4 weeks; phase III, final 4 weeks). Results A continuum of hip rehabilitation exercises was identified. Resisted terminal knee extension, resisted knee flexion, and double-leg bridges were identified as appropriate for phase I and resisted hip extension, stool hip rotations, and side-lying hip abduction with wall-sliding for phase II. Hip clam exercises with neutral hips may be used with caution in patients with hip flexor tendinitis. Prone heel squeezes, side-lying hip abduction with internal hip rotation, and single-leg bridges were identified for phase III. Conclusion/Clinical Relevance This study identified the most appropriate hip rehabilitation exercises for each phase to strengthen the gluteus medius muscle after hip arthroscopy and those to avoid when iliopsoas pain or tendinitis is a concern.

Iliopsoas Cyst Causing Persistent Pain After Total Hip Arthroplasty

Persistent pain after total hip arthroplasty (THA) has many potential causes. The most common are aseptic loosening, infection, and heterotopic ossification. Irritation of the iliopsoas tendon due to the acetabular component is an underestimated cause of persistent groin pain and functional disability after THA with rare incidence. Pain specific to iliopsoas tendonitis includes activities such as hyperextension of the hip, forced flexion, and activities of daily living (eg, ascending stairs). This article presents a case of a 50-year old man with clinical and radiological signs of osteoarthritis of the right hip joint. A THA was performed. After a symptom-free interval of several weeks postoperatively, the patient reported pain projecting from the right groin and radiating ventromedially along the leg. Magnetic resonance imaging of the hip showed a fluid-filled cyst in anatomical proximity to the femoral nerve causing an iliopsoas tendonitis. The patient underwent surgical resection of the cyst was performed by an anterior approach; a conjunction to the hip joint was not present. The implanted components of the prosthesis showed good osseointegration with no signs of loosening. The cyst was removed and the iliopsoas tendon was released. A few weeks after the operation, the patient was pain free. At 17-month follow-up, no problems were reported. In cases such as this, finding the correct diagnosis may be difficult and misleading. Conservative and operative therapeutic options are discussed and compared with divergent findings in the literature.

Complications of Hip Arthroscopy in Children and Adolescents

Hip arthroscopy has become an established procedure for certain hip disorders. Complications of hip arthroscopy have been characterized in adult populations, but complications in children and adolescents have not been well described. The purpose of this study was to characterize complications of hip arthroscopy in children and adolescents. The study design was a retrospective review of 218 hip arthroscopies in 175 patients aged 18 years old and younger over a 9-year period by a single surgeon at a tertiary-care children's hospital. Patient demographics, indications for surgery, and complications after surgery were recorded. Indications for surgery included: isolated labral tear (n=131), labral tear with concomitant hip disorder (n=37), Perthes disease (n=10), hip dysplasia (n=5), juvenile rheumatoid arthritis (n=3), loose bodies (n=3), osteochondral fracture (n=3), synovitis (n=2), avascular necrosis (n=1), chondral lesion (n=1), iliopsoas tendinitis (n=1), and slipped capital femoral epiphysis (n=1). The overall complication rate in the study population was 1.8%. Complications of arthroscopy included: transient pudendal nerve palsy (n=2), instrument breakage (n=1), and suture abscess (n=1). No cases of proximal femoral physeal separation, osteonecrosis, or growth disturbance were noted. Hip arthroscopy in children and adolescents seems to be a safe procedure with a low complication rate similar to adults. IV (case series).

Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints.

Pelvis and Hip Three-Dimensional Kinematics in Grand Battement Movements

Dancers frequently sustain hip injuries, including labral tears, coxa saltans, stress fractures, tendinosis, and joint disease. High velocity kicks (grand battement), with extreme abduction and external rotation (ER), may stress the hip, sacroiliac joint, and surrounding soft tissue. However, three-dimensional kinematic dance descriptions are limited. The purpose of this study was to describe the kinematics of the pelvis and hip in grand battement movements in healthy dancers. Seventeen advanced-level college dancers performed three battement conditions: battement devant to the front, à la seconde to the side, and derrière to the back. Data were collected with a 5-camera motion capture system. Repeated measures ANOVA (p < 0.05) compared peak pelvis and hip angular displacement and hip and toe velocity for all conditions and planes. Three-dimensional hip to pelvic ratios were calculated. There were differences in pelvic angular displacement between conditions in all planes (p < 0.00). Battement devant posterior pelvic tilt exceeded that of battement seconde. Both were opposite in direction from the anterior pelvic tilt of battement derrière. All conditions demonstrated pelvic obliquity toward the stance limb, with battement derrière greater than devant and seconde. Battement derrière transverse plane pelvic displacement exceeded that found in devant and seconde. There were also differences in hip angular displacement between conditions in all planes (p < 0.00). Battement derrière hip extension differed from battement devant and seconde flexion. The hip abducted in all conditions, with battement seconde exceeding devant and derrière. In the transverse plane, the hip rotated internally in battement seconde and externally in battement derrière and devant. In battement devant and seconde, peak hip ER decreased relative to baseline, while increasing at the peak of battement derrière. Battement peak velocities were relatively low. The ratio of hip to pelvic angular sagittal plane motion was 4.1, 2.6, and 0.5 in battement devant, seconde, and derrière respectively; 0.9, 2.6, and 1.5 in the frontal plane; and 0.6, 8.5, and 0.2 in the transverse plane. This confirms that pelvic motion provides a large proportion of the battement movement.

The important role of the arthroscopic hip surgery in the athletes with hip injuries. our experience. a retrospective study

Hip arthroscopy has gradually evolved over the past two decades.Recently hip arthroscopy has increase its role in diagnosis and treatment for specific intraarticular and extraarticular hip injuries and especially for...

A modified Z‐plasty technique for severe tightness of the gluteus maximus

The majority of reports concern external snapping hips caused by the iliotibial band. Comparatively, little information is available regarding snapping hips caused by a gluteus maximus. Here we show that hip problems caused by a tight gluteus maximus can be treated using a modified Z-plasty technique. Fourteen hips in seven patients were diagnosed as snapping hips caused by a tight gluteus maximus. The main functional impairment is that when the hips were flexed, legs were abducted widely and could not be adducted. All had functional impairments irresponsive to conservative treatments besides snapping, whether painful or not, and all patients underwent surgery using a modified Z-plasty technique on the iliotibial band. All patients were followed up and the mean follow-up was 7 years. All patients had complete resolution of functional impairments, snapping, and pain after surgery. No patient needed revision surgery, and there were no complications, such as, abductor weakness, or irritation over the greater trochanter. We suggest that the intrinsic tendon contracture can cause serious functional impairment in patients with snapping due to a tight gluteus maximus. In this context, a modified Z-plasty technique offers a good surgical approach.

Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement

An association between hip pain and quadratus femoris MRI abnormality with concurrent narrowing of the ischiofemoral space has been reported in a number of patients to date, raising the possibility that the muscular damage observed is due to ischiofemoral impingement. Possible impingement has been noted primarily in middle-aged females either with or without a history of trauma or surgery, and associated snapping of the hip is a rarely described feature. We report here on a 17-year-old girl who presented with post-traumatic hip pain; she later developed evidence of ischiofemoral narrowing and quadratus femoris edema on MRI in addition to an audible snapping. Surgical resection of the lesser trochanter was performed, relieving both her hip pain and the snapping. To our knowledge, this is the first reported case of non-iatrogenic ischiofemoral impingement with surgical confirmation. The diagnosis of ischiofemoral impingement should be considered in patients complaining of a snapping hip.

Orthopedic disease and sports medicine related to lower limbs

In this study, the cause, diagnosis, and treatment of common lower limb injuries during the sports activities were presented. Sports injuries of the lower limbs are the most common injuries in the sports medicine field due to the high level of use of the lower limbs during sports activities. The common causes of leg injuries in athletes are traumatic force over the critical limit of normal tissue, repetitive microtrauma, and overuse. Common hip and pelvis problems encountered by the authors include trochanteric bursitis, snapping hip syndrome, and labral tears. The anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, and meniscus have been most frequently involved in sports injuries affecting the knees. Lateral ankle sprain represents one of common injuries in the athletic population. Common overuse injuries are tendinopathies, stress fractures, chronic exertional compartment syndrome, and shin splints. Athletic activity provides a variety of positive benefits to participants’ health. To safely continue those activities, an injury prevention program focusing on injuries that may occur in specific sports activities is recommended for participants. Early diagnosis and proper treatment are also important in promoting prompt recovery and preventing secondary injuries.

Paper 24: Arthroscopic Release of External Snapping Hip Syndrome

Paper 24: Arthroscopic Release of External Snapping Hip Syndrome

Paper 25: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome

External snapping hip syndrome may be caused by either the ITB or gluteus maximus tendon snapping over the greater trochanter. The purpose of this paper is to describe a new endoscopic technique used to decrease the tension of the ITB complex by releasing the femoral insertion of the gluteus maximus tendon.

Imaging of the Tendons About the Pelvis

This article will review the normal anatomy of the pelvic tendons as well as abnormalities such as tendinopathy, partial- and full-thickness tendon tears, myotendinous injuries, snapping hip syndrome, osseous avulsive injuries at tendinous attachments, calcific tendinitis, and tumor. MRI and sonography are useful imaging methods to directly evaluate suspected abnormalities of the pelvic tendons, although tendinous mineralization and associated osseous injuries can also be detected with radiography and CT.

Overview of Thigh Injuries in Dance

Thigh injuries include musculotendinous strains of the quadriceps, hamstrings, adductors, iliotibial band (ITB), and bony injuries to the shaft of the femur. There is scant information in the literature regarding thigh injuries in dance, which appear to range from 5% to 16% of total injury incidence. Hamstring strains and ITB syndrome are the most commonly reported thigh injuries. Hamstring injuries occur most frequently during slow stretching when the dancer's hip is flexed and knee extended. Uniquely in dancers, adductor injury occurs concurrently with hamstring injuries in approximately one-third of cases. Snapping of the ITB at the lateral hip and knee may result from imbalance of thigh muscle strength and flexibility. To date no quadriceps strain injuries or stress injuries to the shaft of the femur have been reported in the dance medicine literature. As dancers notoriously underestimate time needed to return to dance, it can be suggested that early return to work is a contributing factor to chronic injury. Further research is needed regarding the incidence and nature of injury to the thigh among dancers.

Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip

Treatment of painful internal snapping hip (coxa saltans) via arthroscopic lengthening or release of the iliopsoas tendon is becoming preferred over open techniques because of the benefits of minimal dissection, the ability to address concomitant intraarticular disorders, and a low complication rate. Persistent snapping after release is uncommon, especially when performed arthroscopically. Reported causes include incomplete release, intraarticular disorders, and incorrect diagnosis. Anatomic variants are not discussed in the orthopaedic literature. We report a case of an 18-year-old softball player with internal snapping hip treated with arthroscopic iliopsoas release in the peripheral compartment. Postoperatively, the athlete continued to have painful snapping. Repeat arthroscopy with a larger capsulotomy revealed a bifid iliopsoas tendon causing refractory internal snapping hip, which resolved after revision arthroscopic release. Bifid iliopsoas tendon as a cause of persistent snapping of the hip has not been reported in the orthopaedic literature. Prior sonographic and anatomic studies suggest the bifid iliopsoas tendon exists but is uncommon. Recognition that a bifid iliopsoas tendon may be the source of painful internal snapping hip is important to prevent clinical failure of surgical management of the internal snapping hip. The differential diagnosis of failed iliopsoas lengthening surgery should include the consideration of an incompletely lengthened tendon attributable to bifid iliopsoas tendon anatomy. Prevention of this complication includes making a large enough capsulotomy to identify the tendon and to ensure it is not bifid.

Endoscopic Treatment of Snapping Hips, Iliotibial Band, and Iliopsoas Tendon

Indications for endoscopic surgery of the hip have expanded recently. The technique has found a clear indication in the management of snapping hip syndromes, both external snapping hip and internal snapping hip. Even though the snapping hips (external and internal) share a common name, they are very different in origin. The external snapping hip is produced by the iliotibial band snapping over the prominence of the greater trochanter during flexion and extension. Indication for surgical treatment is painful snapping with failure of conservative treatment. The endoscopic technique is designed to release the iliotibial band producing a diamond shape defect on the iliotibial band lateral to the greater trochanter. The defect allows the greater trochanter to move freely without snapping. The greater trochanteric bursa is resected through the defect and the abductor tendons inspected. This procedure is performed without traction and usually only the peritrochanteric space is accessed. If necessary, hip arthroscopy can also be performed. There is limited literature regarding the results of endoscopic treatment for the external snapping hip syndrome, but early reports are encouraging. The internal snapping hip syndrome is produced by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. The snapping phenomenon usually occurs with extension of the hip from a flexed position of more than 90 degree. Two different endoscopic techniques have been described to treat this condition. Iliopsoas tendon release at the level of the hip joint, with this technique the iliopsoas bursa is accessed through an anterior hip capsulotomy and is frequently referred to as a transcapsular release. The second technique is a release at the insertion of the iliopsoas tendon on the lesser trochanter, with this technique the iliospaos bursa is accessed directly. In every report the iliopsoas tendon release has been combined with arthroscopy of the hip joint. It has been documented that more than half of the patients with internal snapping hip syndrome have intra-articular hip pathology. The results of endoscopic release of the iliopsoas tendon in the treatment of internal snapping hip syndrome are encouraging and seem to be better than those reported for open procedures.

Greater Trochanteric Pain Syndrome

Originally defined as "tenderness to palpation over the greater trochanter with the patient in the side-lying position," greater trochanteric pain syndrome (GTPS) as a clinical entity, has expanded to include a number of disorders of the lateral, peritrochanteric space of the hip, including trochanteric bursitis, tears of the gluteus medius and minimus and external coxa saltans (snapping hip). Typically presenting with pain and reproducible tenderness in the region of the greater trochanter, buttock, or lateral thigh, GTPS is relatively common, reported to affect between 10% and 25% of the general population. Secondary to the relative paucity of information available on the diagnosis and management of components of GTPS, the presence of these pathologic entities may be underrecognized, leading to extensive workups and delays in appropriate treatment. This article aims to review the present understanding of the lesions that comprise GTPS, discussing the relevant anatomy, diagnostic workup and recommended treatment for trochanteric bursitis, gluteus medius and minimus tears, and external coxa saltans.

Extra-articular Snapping Hip: A Literature Review

Context:Snapping hip, or coxa saltans, is a vague term used to describe palpable or auditory snapping with hip movements. As increasing attention is paid to intra-articular hip pathologies such as acetabular labral tears, it is important to be able to identify and understand the extra-articular causes of snapping hip.Evidence Acquisition:The search terms snapping hip and coxa sultans were used in PubMed to locate suitable studies of any publication date (ending date, November 2008).Results:Extra-articular snapping may be caused laterally by the iliotibial band or anteriorly by the iliopsoas tendon. Snapping of the iliopsoas tendon usually requires contraction of the hip flexors and may be difficult to differentiate from intra-articular causes of snapping. Dynamic ultrasound can help detect abrupt tendon translation during movement, noninvasively supporting the diagnosis of extra-articular snapping hip. The majority of cases of snapping hip resolve with conservative treatment, which includes avoidance of aggravating activities, stretching, and anti-inflammatory medication. In recalcitrant cases, surgery to lengthen the iliotibial band or the iliopsoas tendon has produced symptom relief but may result in prolonged weakness.Conclusions:In treating active patients with snapping soft tissues around the hip, clinicians should recognize that the majority of cases resolve without surgical intervention, while being mindful of the potential for concomitant intra-articular and internal snapping hips.

An integrated platform for hip joint osteoarthritis analysis: design, implementation and results

We present a software designed to improve hip joint osteoarthritis (OA) understanding using 3D anatomical models, magnetic resonance imaging (MRI) and motion capture. In addition to a standard static clinical evaluation (anamnesis, medical images examination), the software provides a dynamic assessment of the hip joint. The operator can compute automatically and in real-time the hip joint kinematics from optical motion capture data. From the estimated motion, the software allows for the calculation of the active range of motion, the congruency and the center of rotation of the hip joint and the detection and localization of the femoroacetabular impingement region. All these measurements cannot be performed clinically. Moreover, to improve the subjective reading of medical images, the software provides a set of 3D measurement tools based on MRI and 3D anatomical models to assist and improve the analysis of hip morphological abnormalities. Finally, the software is driven by a medical ontology to support data storage, processing and analysis. We performed an in vivo assessment of the software in a clinical study conducted with 30 professional ballet dancers, a population who are at high risk of developing OA. We studied the causes of OA in this selected population. Our results show that extreme motion exposes the morphologically "normal" dancer's hip to recurrent superior or posterosuperior FAI and to joint subluxation. Our new hip software includes all the required materials and knowledge (images data, 3D models, motion, morphological measurements, etc.) to improve orthopedists' performances in hip joint OA analysis.

Iliopsoas Tendonitis Caused by Overhang of a Collared Femoral Prosthesis

Pain after total hip arthroplasty can be due to a variety of causes, one of the less common being iliopsoas tendonitis. We report an unusual case of iliopsoas tendonitis caused by overhang of the femoral calcar by a collared femoral prosthesis resulting in impingement on the iliopsoas tendon. An ultrasound-guided corticosteroid and local anesthetic diagnostic injection to the site of impingement confirmed the diagnosis with temporary symptom relief. Revision of the femoral stem to a collarless prosthesis resulted in immediate and complete resolution of symptoms.

Case Report: Calcific Tendinitis of the Rectus Femoris

Internal snapping hip is a syndrome caused by recurrent subluxation of the iliopsoas tendon. There is little agreement regarding the impinging sites responsible for the jerky motion of the tendon. Thus far, the lesser trochanter, anterior capsule, and iliopectineal eminence are considered the most likely catching sites. We report an unusual case in which a calcific tendinitis of the rectus femoris direct head impinged against the overlying iliacus muscle, resulting in a painful coxa saltans. The exclusive involvement of the direct head hid the calcium deposit on standard radiographs, whereas MRI suggested but poorly showed the tendon disease. Dynamic ultrasonography and CT scanning allowed a precise diagnosis and subsequent treatment with CT-guided steroid injection. Calcific tendinitis of the rectus anterior direct head has not been reported as a possible cause of snapping hip; involvement of the direct head in rectus anterior calcific tendinitis was described in one case. Our case shows the rectus anterior direct head may be involved in the etiology of coxa saltans. Theoretically any thickening of the tendon might activate the same pathomechanism. Physicians should consider this possible new cause of internal snapping hip when the most common ones have been excluded, especially as it may be managed easily with steroid injection.