Snapping Hip Syndrome

A palpable, often audible snap around the hip as a tendon or other structure moves over a bony prominence. Often painless.

Three types

Type	Structure	Location	Clue
External (most common)	ITB or gluteus maximus tendon over the greater trochanter	Lateral hip	Visible snap on flexion-extension. Often with gluteal tendinopathy or bursitis
Internal	Iliopsoas over the iliopectineal eminence or femoral head	Groin	Snap on rising from a chair. Pain with weakness = iliopsoas syndrome
Intra-articular	Labral tear, loose body, chondral flap	Deep joint	Clicking, catching, locking

Mechanism and risk

Repetitive hip flexion-extension, with tight ITB, TFL or iliopsoas
Weak hip abductors (external type). Increased femoral offset predisposes.
Anatomical variants such as a bifid iliopsoas tendon
Overtraining or sudden load increase
Who: dancers (“dancer’s hip”), gymnasts, runners, footballers, martial artists. Female and adolescent patients are more often affected.

Presentation and diagnosis

Reproducible snapping, audible or palpable, often voluntary
Provoked by hip flexion-extension, rising from sitting, walking
Reproduce the snap: external type, extend the hip from flexion-abduction. Internal type, flex and extend the hip supine or lateral.
Trochanteric tenderness and abductor weakness in external type
Intra-articular clues: true catching or locking, positive FADIR or FABER. Image to exclude labral tear or femoroacetabular impingement.

Differential

labral tear, impingement, gluteal tendinopathy, hip osteoarthritis, osteochondral lesion.

Management

Conservative care succeeds in most patients.

Reassurance. Painless cases need no treatment.
Activity modification: avoid the provoking movement.
Hip abductor and deep rotator strengthening: the mainstay.
ITB or iliopsoas stretching: adjunct, with NSAIDs and manual therapy for symptoms.
Corticosteroid injection (trochanteric bursa or iliopsoas sheath): short-term relief for persistent pain.
Surgery (endoscopic ITB release, iliopsoas lengthening): disabling cases failing several months of conservative care. Intra-articular causes need their own treatment, not soft-tissue release.

Nuance

external snapping is often associated with gluteal tendinopathy and greater trochanteric pain syndrome. Treat these concurrently, since the snap alone may not be the pain generator.

References

Snapping Hip Syndrome: A Comprehensive Update, Orthop Rev 2021, doi:10.52965/001c.25088
Orthop Nurs 2018, doi:10.1097/nor.0000000000000499

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.