Coxa saltans

definition

Coxa saltans is one of the orthopedic diseases. The disease is relatively rare. There is the "outer", also "external", Coxa saltans, in which the Iliotibial band on the Greater trochanter of Thighbone jumps. On the other hand, there is the less common “internal”, also “internal” Coxa saltans. Here the tendon of the psoas muscle is affected. The age of onset is 9 to 14 Years, although it is often only diagnosed in middle age (40 years). There are about 5% of the population hit by a snapping hip. It is believed to be more common in women than men.

causes

To understand the cause, one must first become aware of the anatomy of the thigh: the thigh has one tough connective tissue sheath, the "Fascia lata". On the outside of the thigh, this strand of fibers is several centimeters wide. It spans the hip joint like a plate. This area is called the iliotibial band. Normally the iliotibial band should smoothly Slide over the greater trochanter (the large rolling hill on the neck of the thighbone where the gluteal muscles are attached). In the “outer coxa saltans” the tract slides in one too close over. As a result, part of the fiber strand of the iliotibial tract can get caught in the hip joint on the greater trochanter during flexion (flexion) or extension (extension).

Shortly after getting caught, there is a backward jump over the greater trochanter if the tension on the tendon is too great. This is where the name “snapping hip” comes from, as there can be an audible and tactile snapping. Sometimes this also happens with normal walking. Reasons for the tendon to get stuck can be Bursitis be. Likewise can legs of unequal length and the stress it brings with it can cause "hip jumping". Also muscular imbalanceswhich are mostly found in athletes, can cause hip bouncing. Often, however, you cannot find out the reason, so that therapy is also difficult.

In the case of internal coxa saltans, the tendon of the psoas muscle, which pulls over the hip joint at the front, leads to irritation at the socket edge of the femur or the head of the femur.

A Coxa saltans can also be produced by a Bursitis to be triggered.

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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Risk factors

Excessive exercise can be a risk factor for developing a snapping hip because certain movements are often repeated depending on the sport.The “risk sports” include, for example Ballet, gymnastics, horse riding and soccer. Weightlifting or jogging are also part of it, as these sports usually involve an extreme Thickening of the tendons go along in the hip region.

Symptoms

Most patients call it snapping over very uncomfortable felt. There is usually moderate to moderate pain, which is caused by irritation of the affected area. Often times, the pain stops with rest and limited activity. Overall, the movement of the hip is limited: the internal rotation is not fully feasible and the leg can only be difficult be splayed. So every step experiences a short block. With pronounced forms, the person affected can begin to limp. In addition, there may be swelling in the side of the hip.

Diagnosis

Often the coxa saltans is not a clear disease. First of all, a physical exam is necessary, during which you often already the jumping of the iliotibial band can feel. Sometimes it can even be heard. During an examination while lying down, the orthopedic surgeon lets the patient bend and straighten his leg, which is spread outwards (= flexion and extension in adduction position). This should trigger the typical symptoms in an existing coxa saltans. A swelling will be seen if the bursa around the hip joint is inflamed (Synovitis / bursitis). The affected bursa is named Bursa subcutanea trochnanertica.

No pathological changes are visible on ultrasound (sonography).

Likewise, an X-ray usually remains without any pathological findings, unless bony extensions have formed due to previous injuries. An MRI can sometimes identify intra-articular causes of the coxa saltans.

Conservative therapy

The hip is usually snapping curable. Sometimes it even heals spontaneously. If not, is one conservative Therapy or a operational Alternative indexed.

In the case of conservative therapy, generally only Medication and physical therapy ordered and not operated on. NSAIDs (= "non-steroidal anti-inflammatory drugs" such as ibuprofen or diclofenac) are used locally and orally in Coxa saltans. These are not intended as permanent therapy and are only used for temporary Pain-free used. In severe painful cases, local anesthetics are injected into the subcutaneous trochanteric bursa. Glucocorticoids can also be injected. In some cases, removal of the affected bursa may be considered.

Physiotherapy and strength training can also help, which muscular imbalances should compensate. Insoles can compensate for the different leg lengths and are therefore the means of choice for therapy in coxa saltans of this cause. A break from sporting activities can compensate for the overuse of the hip apparatus.

Operative therapy

If conservative therapy does not help, surgery must be considered. Both the internal coxa saltans and the external coxa saltans are in principle arthroscopic treatable. The arthroscopic procedure is used as the method of choice for Coxa saltans interna. The Psoas tendon surgically severed. This is also known as a "tentotomy". The arthroscopic procedure is also the method of choice for coxa saltans externa. In this case, the iliotibial tract can be sutured to the greater trochanter if the symptoms persist.

Another possibility is that Duplication of the muscle fascia or an extension of the tendon. It is also possible to grind the greater trochanter (large rolling hillock) a little. These therapy methods are intended to permanently solve the problem. However, with every operation there are also risks that should be considered, such as possible nerve damage and damage to the blood vessels, so that the cost-benefit principle should be weighed. The Arthroscopy (Arthoscopy) can bring advantages, especially in the area of ​​postoperative wound healing, which should be less complicated with arthoscopy.

Intensive physiotherapy must be carried out after an operation. It can take nine to twelve months to gain full strength.