Snapping Hip Syndrome (Coxa Saltans)

What is it?

Three types: external (IT band over greater trochanter), internal (iliopsoas over pubic eminence), intra-articular (labral/loose body).

Commonly affected: External (greater trochanter), internal (iliopsoas over pubis), intra-articular

How it develops

1. Normal Tendon GlideTendons slide smoothly over bony prominences
2. Repetitive Motion/TightnessDance/sport tightens tendons and muscles
3. Tendon CatchesTendon catches over bony landmark, then snaps
4. Snap + Eventual PainInitially painless snap, later bursitis and pain

Symptoms

• Hip ClickingSnap with hip flexion/extension
• Pain (when present)Tenderness and pain at snap location
• Associated BursitisGreater trochanter tenderness/swelling
• Activity LimitationDiscomfort with dance/running

How it is examined

• Active ReproductionActive hip flexion/extension reproduces snap
• Ober TestAssesses IT band tightness (external type)
• Iliopsoas PalpationTenderness over iliopsoas in internal type

Imaging

X-ray usually normal — rules out intra-articular causes.

• Usually normal
• Rules out intra-articular pathology

Dynamic ultrasound is gold standard for visualizing tendon snap.

• Tendon snap on dynamic US
• Associated bursitis possible
• Rules out intra-articular cause

When surgery is considered

6-month conservative failure with severe pain/disability

Procedures that may be discussed

• IT band Z-lengthening
• Iliopsoas tendon release
• Arthroscopic loose body removal

Outlook

Most become painless with stretching alone.