Injection Technique for Snapping Hip Syndrome

Indications and Clinical Considerations

Snapping hip syndrome, which is also known as coxa saltans, is a constellation of symptoms that include a snapping sensation in the lateral hip associated with sudden, sharp pain in the area of the greater trochanter. The snapping sensation and pain are the result of the iliopsoas tendon subluxing over the greater trochanter or iliopectineal eminence, although there are a number of other causes of snapping hip ( Fig. 131.1 , Table 131.1 ). The symptoms of snapping hip syndrome occur most commonly when the patient rises from a sitting to a standing position or walks briskly. Often, trochanteric bursitis coexists with snapping hip syndrome, further increasing the patient’s pain and disability. The iliotibial band may also produce a snapping sensation as it passes forcefully forward from the greater trochanter during hip flexion ( Fig. 131.2 ).

Physical examination reveals that the patient can recreate the snapping and pain by moving from a sitting to a standing position and adducting the hip ( Fig. 131.3 ). Point tenderness over the trochanteric bursa indicative of trochanteric bursitis also is often present.

Plain radiographs are indicated for all patients with pain thought to be emanating from the hip to rule out occult bony disease and tumor. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, prostate-specific antigen, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging and ultrasound imaging of the affected hip are indicated to help confirm the diagnosis as well as to rule out occult mass or aseptic necrosis of the hip ( Fig. 131.4 ). Ultrasound imaging can also help with the diagnosis ( Fig. 131.5 ). The following injection technique serves as both a diagnostic and a therapeutic maneuver.

Clinically Relevant Anatomy

The trochanteric bursa lies between the greater trochanter and the tendon of the gluteus medius and the iliotibial tract ( Fig. 131.6 ). The gluteus medius muscle has its origin from the outer surface of the ilium, and its fibers pass downward and laterally to attach on the lateral surface of the greater trochanter. The gluteus medius locks the pelvis in place when walking and running. The gluteus medius muscle is innervated by the superior gluteal nerve. The iliopectineal eminence is the point at which the ilium and the pubic bone merge. The psoas and iliacus muscles join at the lateral side of the psoas, and the combined fibers are referred to as the iliopsoas muscle. Like the psoas muscle, the iliacus flexes the thigh on the trunk or, if the thigh is fixed, flexes the trunk on the thigh, as when moving from a supine to sitting position.