MOST LIKELY DIAGNOSIS: Snapping Hip Syndrome
This 20-year-old female presents with hip pain. You are getting two clues for the price of one. First, look at images 1 and 2. The patient has a labral tear, but hip pain is quite an amorphous symptom, and the tear may not be the primary diagnosis. It can come from the joint, the groin, the sacrum, the pubis, or even the spine. We all have a tendency to gravitate towards the joint.
Q1 – Why are we getting two clues for the price of one?
Q2 – Why does the patient have hip pain?
A1 – Because there are two iliopsoas tendons. In other words, the iliopsoas tendon has a bifid morphology (image 1, pink arrows).
A2 – Swelling is more conspicuous around the lateral of the two heads (images 1 and 2, blue arrows). Such swelling is an indirect sign of irritation of the tendon and its surrounding tissues. The iliopsoas tendon is a primary hip flexor and passes over the iliopectineal eminence of the pelvis. This bony prominence is labeled on image 3 (yellow arrow). As the tendons ride over this area, a snap or a click occurs, otherwise known as coxa saltans. Hip flexion and extension, raising and lowering of the whole leg or rotation, namely twisting of the hip, may exacerbate or reproduce symptoms. The peritendinitis, demonstrated with the blue arrows, is a secondary manifestation of this catching phenomenon on the iliopectineal eminence. In this case, the eminence itself is indeed edematous (high signal deep to the yellow arrow on image 3).
Q3 – Names like coxa saltans, or iliopsoas tendonitis perhaps, are given to this condition. Can you think of another name?
A3 – Dancer’s hip.
Some have actually broken down snapping hip tendon syndrome into extra- and intraarticular types.
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Content reviewed: September 8, 2021