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What Is Causing That Snapping Sound in the Hip?

March 2, 2008
Written by: , Filed in: Musculoskeletal Radiology
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Background
Snapping hip syndrome is typically found in young athletes, most often when the hip moves from a frog-lateral position into the neutral position, and is accompanied by sudden pain and an audible snap. The cause can be intra- or extra-articular. The iliopsoas tendon is mostly responsible for extra-articular causes.

The objective of a recent study was to describe new mechanisms for snapping iliopsoas tendon using ultrasound.

The study has concluded that snapping iliopsoas tendon is best evaluated with a dynamic ultrasound examination.

Methodology
The authors performed a retrospective review of video recordings during dynamic sonography. Fourteen patients with 18 snapping iliopsoas tendons were included.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

Results of the Study
Snapping of the iliopsoas tendon was demonstrated in 14 of 18 hips when the hip was moved from the frog-lateral position to the neutral position and the iliopsoas tendon flipping around the iliac muscle and returning abruptly to the pubic bone producing an audible snap. This occurred about midway to neutral position.

The iliopectineal eminence was not involved in the snapping mechanism. Two patients had bifid psoas tendons bilaterally, causing snapping (in three hips) when the bifid tendon heads rolled over each other. In one patient, snapping was produced by iliopsoas tendon impingement over a paralabral cyst. Five patients showed signs of tendinosis.

Conclusions
Snapping of the iliopsoas tendon is most often produced by the tendon flipping over the iliac muscle.

Reviewer’s Comments
Ultrasound has proven of great value in assessment of superficially located structures and specifically dynamic evaluations, as it can be elegantly preformed in real time. However, for assessment of intra-articular causes, ultrasound is of limited value.

Author: Cornelia Wenokor, MD

Reference
Deslandes M, Guillin R, et al: The Snapping Iliopsoas Tendon: New Mechanisms Using Dynamic Sonography.
AJR;
2008; 190 (March): 576-581:

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

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