Snapping hip

• definition

definition

As a snapping hip (Latin: Coxa saltans) is a rare orthopedic disease of the hip. In some cases, the term “Amon's snap hip” is also used, which is the same clinical picture. As a sign of a snapping hip, movements in the hip usually lead to a noticeable and audible "snapping" with possibly additional pain. The diagnosis is often made by examining the hip. The therapy mainly consists of pain-relieving therapy and strengthening exercises to strengthen the muscles.

causes

According to the distinction between an “internal” and an “external” snapping hip, two causes of the disease in the hip area are known. The original cause remains mostly unknown. Occasionally a "Coxa saltans“As a result of overload or after an injury.

• Internal Coxa saltans: This leads to irritation in the area of ​​the edge of the acetabulum or at the head of the thigh bone because the tendon of the psoas muscle slides along there.
• External coxa saltans: Here the symptoms arise from a tendon plate (Iliotibial band), which over a protruding bone on the thigh bone (Greater trochanter = large rolling hill) jumps. This can be triggered in particular when the tendon plate is thickened and particularly when rotating with the hip flexed.

Symptoms

Patients who suffer from a snapping hip mainly complain via a snap in the hip area, which can be heard and felt. Sometimes there is additional pain. When the symptoms occur differs from patient to patient. It often occurs when the hips are flexed or extended, but occasionally also when walking normally.

Most of the patients are middle-aged.

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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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Pain

The symptoms of a hip snapping are not always the same. Some patients suffer from the uncomfortable feeling of Cox saltansbut feel no pain. Others, on the other hand, have a very high level of suffering with severe pain with a snapping hip.
Those affected often only suffer from pain under certain stress or situations, while at other times they are free from pain.
The type of illness is also decisive for whether there is pain or not. An external cox saltans is very often painless, while an internal cox saltans is more often associated with pain.

A so-called bursitis, the inflammation of the Trochanteric bursa, the bursa between the thighbone and the muscles attached there, can also lead to pain as part of the hip snap syndrome.

Other diseases that could be responsible for the symptoms should be excluded, especially if the pain persists. Taking pain reliever medication and doing exercises to build muscle in the thigh can help reduce pain.

Diagnosis

The diagnosis of snapping hip or Coxa saltans can already be established by a clinical examination of the patient.

The examiner moves the hip until the symptoms appear. Palpation of the hip region is also necessary to detect accompanying bursitis on the hip (Subcutaneous trochanteric bursitis) not to be overlooked. Here the area on the side of the hip is swollen and tender. In addition, the pain limits the mobility of the hips.

An x-ray of the hip should also be taken to see any changes in the bones. An ultrasound examination or other imaging procedures can also be added to better visualize the tendons, bursae, etc.

In particularly pronounced and unclear cases, an MRI scan of the hip is particularly valuable. The MRI of the hip shows the soft parts of the hip particularly well, so it can show the tendons, the bursa and, with some restrictions, the hip.
Read more about this topic at: MRI of the hip

therapy

First, an attempt should be made to alleviate the patient's symptoms (especially pain) with the help of conservative therapy methods. If this does not lead to permanent improvement, surgical treatment can be considered.

1. Conservative therapies for the snapping hip

   These therapeutic concepts all aim to alleviate the symptoms, but they do not eliminate the cause. Physiotherapy measures, the intake of pain medication or the intake of preparations containing cortisone are used. It is also possible to treat the affected hip region with painkillers or similar. to infiltrate for relief.
   Usually, non-surgical therapy consists of the local or oral administration of so-called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen or Diclofenac or in the injection of glucocorticoids into the trochanteric bursa, a bursa between the thighbone and the muscles attached here.

2. Operative therapy methods in the Coxa saltans

   In principle, both forms of the snapping hip can be treated surgically. The operation can be done openly or through an arthroscopy of the hip. With the internal Coxa saltans the psoas tendon is usually severed (Tenotomy). The external form is often the Iliotibial band at the Greater trochanter sewn on.
   After the operation, there is usually a reduction in strength in the area of ​​the operated hip. With targeted physiotherapy, however, the function can quickly be taken over by other muscles.
   Of course, the operation presents some risks, such as Bleeding, infection, damage to nerves and lymph and blood vessels, as well as tendons with subsequent reduced mobility. However, every patient is informed about this in detail before the operation.

Exercises to strengthen muscles

Exercise can help reduce discomfort and pain.
It must be noted that the cause of the disease cannot be eliminated with exercise. Instructing the exercises with a physiotherapist is generally recommended in order to learn the technique of the exercise and to achieve the optimal effect of the exercise.

Every exercise that trains the stability in the groin, as well as the lower back and especially the thighs, is suitable for use in a Cox saltans. Stretching the thigh muscles can also help to reduce symptoms in the long term.

Strengthening of the lateral thigh muscles can be achieved, for example, with so-called Thera-bands. By moving the legs apart against tension, either lying down or walking sideways, the crucial muscle groups are trained.
When lying on the side in the forearm support, the critical muscle groups on the thigh as well as the important core stability can be trained by repeatedly lifting the affected leg in a stretched position.

You can read more information on this topic here: Leg muscle training exercises

Taping

Taping is the application of a tape bandage, which is supposed to stabilize individual muscle groups, but there are currently no meaningful studies on the use of a tape bandage in the case of a snapping hip. However, it can be assumed that taping the hip in a Cox saltans can reduce the symptoms to a certain extent. By applying the bandage, those affected perceive the movement in the hip joint more strongly and movement beyond the snapping point may be avoided.

Side effects of the tape dressing can occur and should therefore be taken into account when considering the application of such a dressing. Skin irritation and abnormal sensations, but also increased pain and itching, stand in opposition to the benefits of the tape bandage. Whether a tape bandage is an option in an individual case can best be clarified in a personal conversation with an experienced doctor or physiotherapist.

You can read more information on this topic here: Kinesio tape