Summary

Endoscopic treatment of Snapping Hip Syndrome

Abstract

In the last years, there has been a greater interest in causes of pain hip in young patients. Snapping hip syndrome, also known as Coxa saltans, is an uncommon cause of functional impairment and should be remembered as a diferential diagnosis of Femoroacetabular impact, hip bursitis or tendinitis, much more frequent in daily practice. This lesion can develop in both the athletic and sedentary individuals. The management is mostly conservative, but persistent or recurrent symptoms must be managed surgically. Diagnostic could be late and it is based on clinical evidence; the role of imaging has been discussed as secondary./Case presentation:A 35-year-old woman, smoker and obese, was seen on an outpatient consultation due to a persistent pain in left hip/thigh associated with snapping in some movements and sensation of joint instability during gait. She presented those symptoms in the past 10 years, inicially with conservative management; a surgical procedure was intended a few years earlier, but she become pregnant and the treatment was suspended. The objective examination showed symmetrical hips, without axes deviation, no scars or muscular atrophies. When she flexed her left hip, a lateral snapping was clearly seen. From imaging examinations: the radiograph had no changes. Surgical endoscopic treatment with partial longitudinal posterior tenotomy of iliotibial band and trochanteric bursectomy was performed. She was discharged in the next day .The postoperative period was uneventful. After surgery, she started to walk with partial weight bearing during 4 weeks and progressive load increase, as part of a rehabilitation program. During the 18 months of follow-up, the patient presented a good clinical evolution, there was a residual snapping only with hip abduction and flexion beyond 100 degrees at the beginning/Discussion:5 to 10% of people have asymptomatic hip snapping, without need for any therapy. Snapping hip syndrome is an extra-articular uncommon cause of joint pain. Corresponds to a click and sudden movement of the hip in some positions and it is caused by dynamic impingement between the tendon/muscle and bone prominences during hip flexion. There are three different types, according with the evolved structures: lateral, anterior-medial or posterior. Lateral snapping is most frequent and associated with excessive attrition between the gluteal medium muscle or posterior part of iliotibial band and greater trochanter. Diagnostic is mostly is based on clinical history and physical examination. Imaging tools such as radiography, ultrasound and MRI allow the exclusion of other pathologies (extra or intra-articulars) of hip pain, but are not essential for the diagnosis. The conservative treatment (activities modification, medications for pain relief and rehabilitation) is effective in many cases, but recurrent symptoms after 6 a 12 months must be treated surgically. There are several repair options, depending on location of lesion. The arthroscopic treatment, less invasive, has been increasingly used due the faster recovery, less post operatory pain and less anatomical changes./ Conclusion:Snapping hip syndrome is a well-established cause of functional hip impairment. This case shows the importance of accurate patient assessment, so that early diagnosis and appropriate treatment can be performed. The role of imaging tools, useful for making the differential diagnosis with other conditions that may mimic symptoms, is discussed. Different surgical techniques can be used to correct this mechanical conflict, all effective and with good functional recovery.