Snapping Hip

Reviewed By: Pramod Kerkar, MD, FFARCSI

Snapping Hip or Dancers Hip

Snapping Hip is also known as Dancers Hip. Snapping hip or dancers hip is a condition in which a snapping sensation is felt or snapping sound is heard over the hip joint while running, getting up from a chair, walking, and swinging the leg around. In many patients, the problem of snapping hip or dancers hip can be quite worrisome. Frequent snapping sound is irritating and often causes mild to moderate pain. Athletes and dancers may suffer with leg muscle weakness and pain along with the problem of snapping hip which could restrict their professional performances. The hip joint is also known as acetabulofemoral joint. A hip joint is formed by head of femur sitting within the socket of acetabulum of pelvis. The joint cartilage known as labrum protrudes beyond the circumference of socket and holds the head of femur. The link between head of femur and acetabulum is supported by joint capsule, ligaments, tendon and muscles.

Snapping Hip or Dancers Hip

Types of Snapping Hip

The hip is weight bearing part of the body that also maintains balance and is exposed to wear and tear. Several muscles, tendon and ligaments support hip joint movements. Occasionally in few individuals who are dancers or participate in sports hip joint movement causes snapping sound. The condition is known as hip joint snapping or dancers hip. Snapping sound is heard during hip joint movement like flexion, extension, abduction, adduction and rotation. The condition is classified as external snapping and internal snapping.

External snapping- It is the most common type of dancer hip disease. External snapping sound occurs when tendon or muscle rubs against inflamed bursa, bones or ligaments. If symptoms of snapping hip are ignored, then continuous movement of muscle or tendon against bone can cause muscle and tendon damage. The friction between muscle or tendon against bone is prevented by presence of bursa. In most cases there is always a burse lies between tendon or muscle and bone. A bursa is a sac that is filled with lubricating fluid situated between bone and muscles or tendons. Bursa acts like a cushion and shock absorber during activities. The friction between gluteal and iliopsoas muscle against pelvic bone is prevented by presence of bursa between bone and muscles. Similarly, bursa lies between tendon of fascia latae and pelvis as well as iliotibial band and greater trochanter. The iliotibial band is a wide tendon that passes along the outer side of the hip joint.

External Snapping

The types of external snapping are subdivided as follows-

Hamstring Tendon and Ischial Tuberosity- Hamstring tendon rolls over ischial tuberosity during hip joint movement. The rubbing against inflamed bursa or bone causes snapping sound.

Tensor fascia lata, Iliotibial band and Greater Trochanter- The tensor fascia lata and iliotibial band lies on outer side of pelvis and thigh. Iliotibial band is a longitudinal fibrous band reinforces tensor fascia lata. Tensor fascia lata continues as fibrous band known as iliotibial tract or band. The upper end of the band and tensor fascia lata is attached to iliac crest over the outer side of the pelvis and predominantly known as tensor fascia lata. Lower end is attached to the lateral condyle of the tibia bone and known as iliotibial band. The tensor fascia latae and iliotibial band stabilizes the hip and knee joint during walking, running and sprinting activities. The iliotibial band and part of tensor fascia lata passes over the outer surface of greater trochanter of femur bone. The iliotibial band and tensor fascia lata continuously moves over the greater trochanter or greater trochanter bursa during activities. The rubbing of fibrous band over greater trochanter of bursa causes snapping.

Tensor Fascia Lata

Iliopsoas Tendon and Iliopectineal Prominence- Iliopsoas muscle supports hip joint movement. Iliopsoas muscle lies over the iliopectineal eminence. The bursa between iliopsoas muscle and iliopectineal eminence prevents the friction between muscle and bone. Contraction of iliopsoas muscles causes rubbing of bursa between femoral head and tendon or iliopectineal eminence that results in snapping.

Tendons of gluteus maximus and greater trochanter

The upper portion of gluteus maximus muscle is attached to iliac crest and ilium that is part of pelvic bone. Lower end of muscles passes across greater trochanter and attaches to gluteal tuberosity, iliotibial band and fascia lata. Gluteus maximus muscle contracts during extension and rotation of leg at hip joint. Upper fibers of gluteus medius also contracts during abduction of lower leg at hip joint. Gluteus maximus rubs against greater trochanter during contraction and relaxation. Friction as well as rubbing of muscle against greater trochanter and greater trochanter bursa causes snapping hip.

Internal Snapping- Internal snapping is less common than external snapping of hip. Internal snapping is observed in elderly suffering with degenerative hip joint disease as well in all ages secondary to hip joint injury. Fracture of labrum, fracture hip joint cartilage, hip joint ligamental tear and joint capsule injuries causes snapping sound and feel, during movements of hip joint. The causes of internal snapping are sub type as follows-

Internal Snapping

Fracture of cartilage of hip joint- Fracture of joint cartilage causes internal snapping during joint movement. The snapping in such cases is associated with moderate to severe pain.

Degenerative joint disease- Degenerative hip joint disease causes thinning of joint cartilages. The thinning of cartilage causes snapping sound during joint movement.

Inflammatory joint disease- The inflammatory joint disease like rheumatoid arthritis causes loosening of joint capsule and ligaments. The loose joint snaps during hip joint movement.

Tear of hip joint capsule and ligament- Capsule and ligaments are tightly adhere to outer covering of head of femur and edge of acetabulum as well as cartilage labrum. Injury of capsule and ligament resulting in tear or dislocation from its attachment to joint causes partial slippage of head of femur out of socket. Such partial in and out movement of head in socket causes snapping hip.

Causes of hip joint snapping

Internal type of snapping hip is observed in individual suffering with injury of joint capsule, ligaments and joint cartilage. Similarly, degenerative diseases like osteoarthritis and inflammatory joint disease like rheumatoid arthritis also causes internal type of snapping hip. The external type of snapping hip is observed in individual suffering with inflamed bursitis and rubbing of tendon or muscles over the bursa or bones. The causes of internal or external hip joint snapping are as follows-

Snapping Hip Problem is More Likely Among Gymnasts and Ballet Dancers

Inflamed bursa- The external type of painless snapping hip is observed when muscle and tendon rubs against bursa or bony prominence. Such friction of tendon and muscles against inflamed bursa causes snapping as well as mild to moderate pain. The example of external snapping hip is rubbing between iliotibial band and bursa sitting over greater trochanter or bursa between pelvis and gluteal muscles. Similarly, rubbing of inflamed bursa between psoas muscle and iliopectineal eminence causes snapping sound during hip joint movements such as flexion, extension, abduction and rotation.

Direct impact of hip joint- Direct impact of hip joint following fall or hit by a moving object causes injury of bursa, tendon, muscle and joint capsule. Impact over hip joint can cause external as well as internal snapping hip.

Degenerative hip joint disease- Degenerative hip joint disease causes degenerative changes of labrum, joint capsule, bursa, tendon and ligament. Such changes result in external as well as internal snapping hip. Injury caused by direct impact or fall may cause inflammation of bursa and tear of joint structures. Joint movement often causes rubbing of inflamed tissue or abnormal joint movement resulting snapping of hip joint.

Inflammatory hip joint disease- Inflammatory hip joint disease causes loose capsule and cartilages. The loose abnormal joint causes internal snapping sound during joint movement.

Repeated hip joint movement- External Snapping Hip Problem is more likely among gymnasts and ballet dancers. This condition is a kind of overuse sports injury. Inflexible and weak medial hip rotators, tight iliotibial band, gluteus maximus and tensor fascia latae can cause your hips to snap.

Wrong twist and turn- Individuals involved in dynamic activities such as gymnastics, football, running, and ballet dancing occasionally may make wrong twist and turn. Such twist and turn causes abnormal coordination between various groups of muscles resulting in injury of capsule, bursa or cartilages followed by external or internal snapping of hip.

Symptoms and Signs of Snapping Hip or Dancer's Hip

Some of the common symptoms and signs are as follows-

Pain- In most cases mild pain is observed during early stages of snapping hip. Pain mostly localized over hip joint and groin. Initial mild to moderate pain is felt over groin and hip. Later if initial symptoms are ignored then pain become moderate to severe and refer to groin and buttocks. Pain become predominant symptom if bursa is inflamed or hip joint cartilage is injured. Patient may not feel additional pain because of snapping hip if suffering with rheumatoid or osteoarthritis. Pain is common with internal hip snapping.

Clicking and Snapping- Patient feel and may hear snapping over groin and in front of hip joint. The snapping is felt only during hip joint movement. Individual do not feel snapping or hear clicking when comfortable and at rest.

Abnormal gait- Individual suffering with snapping hip or dancers hip may change normal gait to limping gate. Abnormal gate is to avoid causing snapping or initiating pain. Most may avoid putting weight on snapping hip.

Restricted joint movement- Few individuals suffering with snapping or dancing hip avoid or restrict hip joint movement. Prolong restricted hip joint movement may cause stiff hip joint.

Tests to Diagnose Snapping Hip or Dancers Hip

Examination- The initial step taken for diagnosing snapping hip or dancers hip is to find out its exact site where snapping is felt or heard. Then also evaluate the site where the pain is predominant. A thorough examination of the painful joint is necessary. Examination includes the joint movement to find out which tendon or muscle is involved in snapping hip. Examination is performed in standing and lying down position. The joint movement is tested in active and passive movement. Active movement are tested by asking patient to move the joint in different position. Passive test is performed in lying down position. During passive test examiner will move the joint in different position to induce snapping and pain. Moving hip joint in different position pinpoints the pain. Hyper joint movement is performed during flexion, extension, abduction, adduction and rotational movement of hip joint.

Ultrasound Examination- Inflamed bursa and soft tissue injuries are diagnosed using ultrasound examination. Ultrasounds examination involves placement of probe over the hip joint and ultrasound is passed from probe to skin, deeper tissue and hip joint. The information associated with rebound ultrasound waves is analyzed and compounded into images by computer software and analysis. The soft tissue and joint abnormalities are observed in ultrasound images.

Radiological studies- Radiological studies like X-Ray, CT Scan and MRI are performed to rule out fracture, dislocation and soft tissue infection (abscess). CT scan and MRI of soft tissue may show inflamed bursa, hypertrophied ligament and muscles.

Treatment for Snapping Hip or Dancers Hip

Individual suffering with painless snapping hip or dancers hip may get better with regular exercise therapy that is described at the bottom of this chapter. Cold therapy is an effective treatment to relieve pain associated with dancer’s hip. Anti-inflammatory medications such as ibuprofen, aspirin, and naproxen may help in reducing discomfort associated with this condition and also treat inflammation associated with inflamed bursa and osteoarthritis. Corticosteroid injections are helpful to treat inflammation and pain. Modification of daily activities, exercises and sport activities are essential to prevent aggravation of symptoms. Swimmer, dancer and runner should avoid repetitive movement of the hip, which is showing sign of snapping. Stretching exercises are also helpful in reducing discomfort.

Rest- The snapping of hip during early stages is preferably treated with rest. Avoiding activities that aggravate the symptoms of snapping hip helps to prevent aggravation of symptoms. If the cause of snapping is inflammation of bursa or mild injury of hip joint then in most cases snapping may disappear following rest and restricted activities lasting for one to two weeks. In few cases of snapping hip with no pain rest may follow restricted activities for another 3 to 4 weeks resulting in disappearance of symptoms.

Heat and cold therapy- The minor hip joint injury of labrum, ligament and tendon that may be causing snapping or dancer hip is often responds to heat or cold therapy. Cold therapy helps to reduced pain and improve joint movement, while heat treatment improves circulation and reduces inflammation. Heat and cold treatment prevents snapping by reducing the rubbing between the inflamed or injured tissue with bone, tendon and muscle.

Physical therapy- Physical therapy is advised to improve joint movement and flexibility. Hyperextension, hyperflexion, abduction and adduction exercises are performed to improve joint flexibility. Physical therapy prevents joint stiffness and reduces post inflammatory scarring.

Medications- Medications are prescribed to treat bursitis, pain and infection. Inflammation and pain is treated with NSAIDs and infection is treated with antibiotics. Diseases like osteoarthritis and rheumatoid arthritis is treated with specific recommended medications.

NSAIDs- Nonsteroidal anti-inflammatory medications are prescribed for bursitis, minor injury resulting in snapping hip as well as osteoarthritis. Most often NSAIDs prescribed are Ibuprofen, Naproxen and celebrex. NSAIDs are also prescribed to treat osteoarthritis when associated with hip snapping.

Tramadol- Tramadol is synthetic analgesics. Tramadol binds to pain receptors in brain and spinal cord. Tramadol like opioids causes dependence and addiction. Tramadol is prescribed if patient is unable to tolerate NSAIDs. Tramadol is less effective as an analgesic than some of the opioids like morphine and oxycodone.

Opioids- Opioids are prescribed for severe pain and very rarely needed for snapping hip. Opioid causes dependence and addiction and must be used for short period lasting between 1 to 2 weeks. Opioid also causes nausea, vomiting and constipation.

Disease modifying antirheumatic drugs (DMARDs)- Medications classified as DMARDs are prescribed for rheumatoid arthritis if associated with hip snapping. The medications classified under DMARDs group are methotrexate, Leflunomide (arava), hydrocychloroquine (Plaquenil) and sulfasalazine (azulfdine). Medication included in DMARDs causes several side effects and most significant are liver damage, bone marrow suppression and lung infection.

Cortisone Injection- Inflammation of tendon, muscle, bursa and hip joint is treated with cortisone injection when not infected. Cortisone injection helps to relieve pain and snapping that is not responding to NSAIDs. Following diagnosis and careful evaluation of cause of pain patient is schedule for injection treatment. The procedure is performed in surgical center under aseptic condition. The needle is placed under image intensifier or ultrasound near the bursa, tendon, muscle or bone that is causing the pain.

Antibiotics- Antibiotic treatment is rarely needed unless trauma results in infection of bursa as well as abscess formation around hip joint involving muscles and tendon. The antibiotics are prescribed after blood examination and aspiration of fluid from infected bursa or abscess. The aspirated fluid is tested to evaluate the cause of infection and antibiotic sensitivity of the causative bacteria so appropriate antibiotics are prescribes. Most infection of bursa, joint and soft tissue are caused by staphylococcus aureus and streptococcus pyogenes.

Surgery- Surgery is the final choice of treatment and rarely needed. Surgery is advised if snapping hip is painful and restrict daily activities.

Arthroscopy surgery- Arthroscopy is performed using tubular thin cylindrical camera. The arthroscope is connected to television monitor so large images of the joint, bursa, muscle and tendon are seen on monitor. The initial procedure is performed to evaluate the cause of pain. Arthroscopic surgery is performed to remove inflamed bursa and procedure is known as bursectomy. In few cases surgery involves shaving of thick iliotibial band or greater trochanter.

Open surgery- Rarely patient is considered for open surgery. Open surgical procedure is recommended when all conservative and invasive treatment fails to relieve snapping and pain. The surgical procedure is performed to reposition tendon, muscle and fascia latae. Surgical procedure also recommended to shave the bones that is rubbing the tendon or muscle.

Exercises- Exercises are recommended for treatment of snapping hip. In most cases exercise is advised after snapping hip is cured from symptoms to prevent recurrence of similar symptoms. Patient is advised to avoid activities that aggravate the symptoms of snapping hip. Exercises are performed daily or 4 times a week.

Exercises for Snapping Hip or Dancers Hip

Quadriceps Stretch Exercise:

Suffering From Snapping Hip?  Performing Quadriceps Stretch Exercise Can Be Beneficial!

This exercise is useful to overcome the problems of Snapping hip or dancers hip. Exercise is performed in standing position. The right hand is placed over table or right hip is tightly placed against the wall as shown in picture. Once the standing position is supported then exercise is performed to stretch opposite hip (left hip). Grab the ankle with left hand and flex the knee as much as you can. Then stretch the left leg backward with ankle flex at knee and supported by left hand as far as possible. Hold the position for about 30 to 60 seconds and release. Repeat 4 to 5 time. The exercise can be repeated twice a day.

Hamstring Stretch Exercise for Snapping Hip or Dancers Hip:

For Problems Related to Snapping Hip, Performing Hamstring Stretch Exercise Can Be Beneficial!

Hamstring Stretch Exercise is beneficial to relieve snapping hip when snapping is caused by hamstring tendon rubbing ischial tuberosity or iliotibial band lies over greater trochanter. Hamstring stretch exercise is performed by lying supine with the flat back on the floor between the doorway in order to keep the upper half of the body on one side of the doorway and the lower half of the body on the other side placing the affected hip against the frame of the door. Now, raise the affected leg in order to rest it along the wall present next to the frame of the door. Hold the position for about 30 to 60 seconds and drop. Repeat it thrice.

Piriformis Stretch Exercise:

Suffering From Snapping Hip? Performing Piriformis Stretch Exercise Can Be Beneficial!

The exercise helps to relieve pain caused by iliopsoas tendon causing friction against iliopectineal prominence. Exercise also helps to stretch the Fascia latae and gluteus maximus over greater trochanter. Piriformis stretch exercise for snapping hip or dancers hip is performed by lying down supine with the back straight touching the exercise carpet. Next bend the knee and hip of affected leg (left leg) and rest the feet on thigh of opposite normal leg. Now flex the normal right leg at hip and knee joint so the right foot is floating in the air as shown in picture. Hold the thigh of normal leg with both hand and pull toward chest. Hold the position for about 30 to 60 seconds and release. Repeat same exercise 5 time.

Iliotibial Band Stretch Exercise for Snapping Hip or Dancers Hip:

For Problems Related to Snapping Hip, Performing Iliotibial Band Stretch Exercise Can Be Beneficial!

Exercise is performed when snapping hip is causes by rubbing of fascia latae and gluteus maximus over greater trochanter. Exercise also helps to relieve symptom when snapping is caused by inflamed bursa or iliotibial band rubbing greater trochanter. Iliotibial band stretch is performed by standing with the legs joined together. Now cross the healthy leg in front of the affected leg and bend down to touch the toes. Hold the position for about 30 seconds and release. Repeat the exercise 5 time.

Also Read:

References

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: September 27, 2018

This article does not provide medical advice. See disclaimer

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