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Coxa Saltans: Iliopsoas Snapping and Tendonitis

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Hip Arthroscopy and Hip Joint Preservation Surgery

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Abstract

Coxa saltans, or snapping hip, is a clinical condition characterized by an audible or palpable snapping sensation that may be heard during movement of the hip joint. Snapping hip has multiple etiologies and has been classified based on the anatomic structure that is the cause of the snapping phenomenon.

Two main snapping hip categories have been recognized (Extra-articular and Intra-articular). Extra-articular snapping may be further divided into external snapping and internal snapping. External snapping hip is most commonly attributed to the iliotibial band moving over the greater trochanter during hip movements in flexion, extension, and external or internal rotation. Internal snapping hip most commonly occurs as the iliopsoas tendon snaps over underlying bony prominences, such as the iliopectineal eminence. The snapping sensation can closely mimic intra-articular pathology and can cause irritation and inflammation of the tendon, since they both originate from the anterior portion of the hip. Meticulous physical examination and imaging can differentiate the origin of the snapping. Treatment options must be chosen on an individual patient basis (conservative versus surgical).

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References

  1. Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–55.

    PubMed  Google Scholar 

  2. Jacobsen JS, Kersting UG, Rathleff MS, et al. The gait pattern is not impaired in subjects with external snapping hip: a comparative cross-sectional study. BMC Musculoskelet Disord. 2013;14:212.

    PubMed  PubMed Central  Google Scholar 

  3. Allen WC, Cope R. Coxa Saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3:303–8.

    CAS  PubMed  Google Scholar 

  4. Kingzett-Taylor A, Tirman P, Feller JA, et al. Tendinosis and tears of the gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR. 1999;173:1123–6.

    CAS  PubMed  Google Scholar 

  5. Larsen E, Johansen J. Snapping hip. Acta Orthop Scand. 1986;57:168–70.

    CAS  PubMed  Google Scholar 

  6. Choi YS, Lee SM, Song BY, et al. Dynamic sonography of external snapping hip syndrome. J Ultrasound Med. 2002;21(7):753–8.

    PubMed  Google Scholar 

  7. Azizi HF, Lee SW, Oh-Park M. Ultrasonography of snapping hip syndrome. Am J Phys Med Rehab. 2014;94(1):e10–1. https://doi.org/10.1097/PHM.0000000000000217.

    Article  Google Scholar 

  8. Pelsser V, Cardinal E, Hobden R, et al. Extraarticular snapping hip: sonographic findings. AJR. 2001;176(1):67–73.

    CAS  PubMed  Google Scholar 

  9. Blaichman JI, Chan BY, Michelin P, Lee KS. US-guided musculoskeletal interventions in the hip with MRI and US correlation. RadioGraphics. 2019;40:181. https://doi.org/10.1148/rg.2020190094.

    Article  PubMed  Google Scholar 

  10. Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, et al. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22:505–10.

    PubMed  Google Scholar 

  11. Nam KW, Yoo JJ, Koo KH, et al. A modified Z-plasty technique for severe tightness of the gluteus maximus. Scand J Med Sci Sports. 2011;21:85–9.

    CAS  PubMed  Google Scholar 

  12. Polesello GC, Queiroz MC, Domb BG, et al. Surgical technique: endoscopic gluteus maximus tendon release for external snapping hip syndrome. Clin Orthop Relat Res. 2013;471:2471–6.

    PubMed  Google Scholar 

  13. Yoon TR, Park KS, Diwanji SR, et al. Clinical results of multiple fibrous band release for the external snapping hip. J Orthop Sci. 2009;14:405–9.

    PubMed  Google Scholar 

  14. Voos JE, Rudzki JR, Shindle MK, et al. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23:1246.e1–5.

    PubMed  Google Scholar 

  15. Provencher MT, Hofmeister EP, Muldoon MP. The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med. 2004;32(2):470–6. [PubMed: 14977676]

    PubMed  Google Scholar 

  16. White RA, Hughes MS, Burd T, et al. A new operative approach in the correction of external coxa saltans: the snapping hip. Am J Sports Med. 2004;32(6):1504–8. [PubMed: 15310578]

    PubMed  Google Scholar 

  17. Yi SR, Lee SH, No JH, Park JM. The surgical treatment of external snapping hip by modified Z-plasty (N-plasty) of the iliotibial band. J Korean Hip Soc. 2008;20:315–9.

    Google Scholar 

  18. Nunziata A, Blumenfeld I. Snapping hip; note on a variety. Prensa Med Argent. 1951;38:1997–2001.

    CAS  PubMed  Google Scholar 

  19. Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle: anatomical basis of anterior snapping of the hip. Surg Radiol Anat. 2001;23:371–4.

    CAS  PubMed  Google Scholar 

  20. Bureau NJ. Sonographic evaluation of snapping hip syndrome. J Ultrasound Med. 2013;32:895–900. https://doi.org/10.7863/ultra.32.6.895.

    Article  PubMed  Google Scholar 

  21. Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanism using dynamic sonography. Am J Roentgenol. 2008;190(3):576–81.

    Google Scholar 

  22. Ilizaliturri VM, Suarez-Ahedo C, Acuña M. Internal snapping hip syndromIncidence of multiple-tendon existence and outcome after endoscopic transcapsular release. Arthroscopy. 2015;31(10):1991–5.

    PubMed  Google Scholar 

  23. Ilizaliturri VM. Chapter 18 – Arthroscopic iliopsoas release and lengthening. In: Sekiya JK, Safran MR, Ranawat AS, Leunig M, editors. Techniques in hip arthroscopy and joint preservation surgery. W.B. Saunders; 2011. p. 152–8. ISBN 9781416056423.

    Google Scholar 

  24. Awad MAH, Bajwa AK, Slaunwhite E, Logan KJ, Wong IH. Indications for hip arthroscopy in pediatric patients a systematic review. J Hip Preserv Surg. 2019;6(4):304–15.

    PubMed  PubMed Central  Google Scholar 

  25. Ross JR, Larson CM, Bedi A. Indications for hip arthroscopy. Sports Health. 2017;9(5):402–13.

    PubMed  PubMed Central  Google Scholar 

  26. Piechota M, Maczuch J, Skupiński J, Kukawska-Sysio K, Wawrzynek W. Internal snapping hip syndrome in dynamic ultrasonography. J Ultrason. 2016;16(66):296–303.

    PubMed  PubMed Central  Google Scholar 

  27. Giai Via A, Fioruzzi A, Randelli F. Diagnosis and management of snapping hip syndrome: a comprehensive review of literature. Rheumatol Curr Res. 2017;07(04). https://doi.org/10.4172/2161-1149.1000228.

  28. Taylor GR, Clarke NMP. Surgical release of the snapping iliopsoas tendon. J Bone Joint Surg Br Vol. 1995;77-B(6):881–3.

    Google Scholar 

  29. Contreras MEK, Dani WS, Endges WK, De Araujo LCT, Berral FJ. Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip. J Bone Jt Surg Br Vol. 2010;92-B(6):777–80.

    Google Scholar 

  30. Khan M, Adamich J, Simunovic N, Philippon MJ, Bhandari M, Ayeni OR. Surgical management of internal snapping hip syndrome: a systematic review evaluating open and arthroscopic approaches. Arthroscopy. 2013;29(5):942–8.

    PubMed  Google Scholar 

  31. Ilizaliturri VM Jr, Chaidez C, Villegas P, et al. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009;25(2):159–63.

    PubMed  Google Scholar 

  32. Ilizaliturri VM Jr, Buganza-Tepole M, Olivos-Meza A, et al. Central compartment release versus lesser trochanter release of the iliopsoas tendon for the treatment of internal snapping hip: a comparative study. Arthroscopy. 2014;30(7):790–5.

    PubMed  Google Scholar 

  33. Blomberg JR, Zellner BS, Keene JS. Cross-sectional analysis of iliopsoas muscle-tendon units at the sites of arthroscopic tenotimies: an anatomic study. Am J Sports Med. 2011;39(Suppl):58S–63S.

    PubMed  Google Scholar 

  34. Johnston CA, Wiley JP, Lindsay DM, et al. Iliopsoas bursitis and tendinitis. A review. Sports Med. 1998;25(4):271–83.

    CAS  PubMed  Google Scholar 

  35. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40:2720–4.

    PubMed  Google Scholar 

  36. Charbonnier C, Kolo FC, Duthon VB, et al. Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2011;39:557–66.

    PubMed  Google Scholar 

  37. Micheli LJ, Solomon R. Treatment of recalcitrant iliopsoas tendinitis in athletes and dancers with corticosteroid injection under fluoroscopy. J Dance Med Sci. 1997;1:7–11.

    Google Scholar 

  38. Ala Eddine T, Remy F, Chantelot C, Giraud F, Migaud H, Duquennoy A. Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:815–9.

    CAS  PubMed  Google Scholar 

  39. Capogna BM, Shenoy K, Youm T, Stuchin SA. Tendon disorders after total hip arthroplasty: evaluation and management. J Arthroplast. 2017;32(10):3249–55.

    Google Scholar 

  40. Odri GA, Padiolleau GB, Gouin FT. Oversized cups as a major risk factor of postoperative pain after total hip arthroplasty. J Arthroplast. 2014;29(4):753–6.

    Google Scholar 

  41. Dora C, Houweling M, Koch P, Sierra RJ. Iliopsoas impingement after total hip replacement: the results of non-operative management, tenotomy or acetabular component revision. J Bone Joint Surg Br. 2007;89(8):1031–5.

    CAS  PubMed  Google Scholar 

  42. Brandemburg JB, Kapron AL, Wylie JD, et al. The functional and structural outcomes of arthroscopic iliopsas release. Am J Sports Med. 2016;44:1286–91.

    Google Scholar 

  43. Andersson E, Oddsson L, Grundstrom H, et al. The role of the psoas and iliacus muscle for stability and movement of the lumbar spine, pelvis and the hip. Scand J Med Sci Sports. 1995;5:10–6.

    CAS  PubMed  Google Scholar 

  44. Duplantier NL, McCulloch PC, Nho SJ, et al. Hip dislocation or subluxation after hip arthroscopy: a systematic review. Arthroscopy. 2016;32:1428–34.

    PubMed  Google Scholar 

  45. Fabricant PD, Bedi A, De la Torre K, Kelly BT. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. Arthroscopy. 2012;28:956–71.

    Google Scholar 

  46. Hartigan PE, Peters I, Close MR, et al. Arthroscopic treatment of iliopsoas snapping in patients with radiographic acetabular dysplasia using iliopsoas fractional lengthening and capsular plication. Arthroscopy. 2018;34(6):1841–50.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Adult Joint Surgery, National Rehabilitation Institute of Mexico, Mexico City, Mexico

    Victor M. Ilizaliturri Jr & Carlos Suarez-Ahedo

Authors
  1. Victor M. Ilizaliturri Jr
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  2. Carlos Suarez-Ahedo
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Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Houston Methodist Center for Orthopaedics and Sports Medicine, Houston, TX, USA

    Joshua D. Harris

  2. Rush University Medical Center, Chicago, IL, USA

    Joshua D. Harris

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Ilizaliturri, V.M., Suarez-Ahedo, C. (2021). Coxa Saltans: Iliopsoas Snapping and Tendonitis. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_64-2

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-2

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  • Print ISBN: 978-1-4614-7321-3

  • Online ISBN: 978-1-4614-7321-3

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Chapter history

  1. Latest

    Coxa Saltans: Iliopsoas Snapping and Tendonitis
    Published:
    01 December 2021

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-2

  2. Original

    Coxa Saltans: Iliopsoas Snapping and Tendonitis
    Published:
    15 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_64-1

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