Anatomy:Externally from the iliac crest to the shin bone runs a strong tendon (tractus iliotibialis), on which many of the thighs muscles are fastened. The tendon runs close above the outer femoral bone projection (trochanter major).
Cause: With repeated movements in the knee and hip joint (running, dancing, gymnastics) the powerful tendon (tractus iliotibialis) slips over the outer bone projection (trochanter major) of the femur, which can cause inflammation in the tendon or in the underlying bursa. When the inflamed tendon slips over the bone projection, a sudden, slipping, and unpleasant sensation can be felt. There are three known causes of snapping hips: outer snapping hip (tractus iliotibialis), inner snapping hip (iliopsoas tendon) and joint conditioned (intraarticular) causes, Coxa Saltans: The Snapping Hip Revisited (article).
Symptoms: Upon certain movements in the hip joint, a sudden slipping, and unpleasant sensation can suddenly be produced on the outside of the thigh, which is often audible.
Examination: Usually the diagnosis can be made by an ordinary medical examination. You can often prevent the tendon from slipping over the outer bone projection by holding the tendon aside, while the movements provoking the condition are performed. The pain will decrease for approx. one hour after the injection of a local anaesthetic (diagnostic blockade) around the outer hip bone projection. If the diagnosis does not appear to be certain, ultrasound is recommended (Ultrasonic image), (article), or possibly a MRI scan.
Treatment: The treatment primarily comprises relief, stretching of the external tendon and rehabilitation. It is crucial that shoes have good shock absorbing soles. In cases of inappropriate foot stance, this should be corrected with shoes or inlays. In case of lack of progress the treatment can be supplemented with medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid, which advantageously can be guided by ultrasound. In severe cases with no effect from relief, correct rehabilitation or medical treatment, you can operatively split the tendon.
Complications: In case of lack of progress it should be considered whether the diagnosis is correct. This will often require supplemental examinations (X-ray, ultrasound or MRI scan). In particular the following should be considered:
Special: Shock absorbing shoes or inlays will reduce the load. In case of lack of progress or recurrences after successful rehabilitation it can be considered to have a running style analysis performed, to evaluate whether correction of the running style is indicated.