Snapping Hip Syndrome (Iliopsoas Impingement +/- Hip Replacement)

Snapping hip syndrome is a condition where hip movements during running, walking, or rising from a chair cause snapping that is felt or heard in the groin (internal snapping). It affects 5-10% of the population.

It is also called dancer’s or jumper’s hip because it is typically found in athletes like runners, dancers, and high jumpers, but it can affect anyone. It causes groin pain and intermittent catching, snapping, or popping of the hip.

Snapping hip syndrome has multiple causes but is commonly due to overuse that occurs when the iliopsoas tendon becomes inflamed (tendonitis) from excessive or abnormal motion of the hip joint. The thickened and inflamed tendon snaps over an underlying boney prominence of the socket (iliopsoas impingement), or prominent artificial hip component, causing clicking and pain.

Excessive or abnormal motion of the hip joint can be precipitated by labral tears secondary to hip instability (dysplasia) or femoroacetabular impingement (FAI). The iliopsoas tendon can also be injured by inflammatory / degenerative arthritis or following total hip replacement and hip resurfacing where a prominent acetabular cup causes injury and pain to an overriding iliopsoas tendon. It is associated with iliopsoas bursitis and other musculoskeletal disorders. Female athletes are at higher risk.

Snapping hip syndrome can be painless, cause mild discomfort or sharp pain in the front of the hip/groin region. When pain is present it may be perceived as severe back pain. Patients often describe the symptoms as snapping or locking of the hip with an audible click. Symptoms typically increase over time.

Symptoms may include:

• back pain when walking
• snapping pain with rotational motion
• clicking when moving from sitting to standing
• painful audible snap when running, sprinting, squatting, kneeling
• difficulty standing upright
• a limp or shuffling gait
• tenderness on palpation to the groin
• decreased range of motion due to apprehension of snapping

Symptoms can worsen with activity and improve with rest. Radiating pain can extend to the knee. The snapping of the iliopsoas muscle leads to inflammation and fluid accumulation in the iliopsoas bursa and causes bursitis deep within the groin.

The experts at LALL Orthopedics ⁺ will inquire about your symptoms and what causes your pain. They will review your medical history and conduct a comprehensive lower back, hip and knee physical exam including testing gait, strength, and range of motion. They will perform special tests to reproduce the snapping which will help identify the root cause for the associated hip flexor tendonitis. Nearly 50% of patients with internal snapping hip syndrome also have other hip conditions such as a hip labral tear.

Imaging can help to determine the origin of your hip pain and rule out/in other hip conditions. Diagnostic local anesthetic injections, performed under ultrasound guidance by expert clinicians, in the affected area can help to distinguish the cause. If the injections reduce pain this indicates the cause is psoas tendonitis.

Most patients who are in pain find relief with conservative management including rest, activity modification, icing, over the counter anti-inflammatory medications, physical therapy, and cutting-edge pain-relieving biologic injections such as platelet-rich plasma (PRP) or Stem-Cell injections. When this approach fails to relieve symptoms, minimally-invasive surgical interventions may be recommended. Only few surgeons are trained to perform arthroscopic hip surgery for internal snapping hip syndrome, but this procedure has been pioneered, researched and optimized by the clinicians at LALL Orthopedics +.