Coxa saltans (CS), also known as snapping hip
- is a benign condition characterized by an audible and sometimes painful snapping, which occurs with flexion and extension of the hip
- there are three types of coxa saltans:
- external type
- the most common and is caused by movement of the iliotibial band (ITB) over the greater trochanter, formed from the tensor fascia anteriorly and the gluteus maximus posteriorly
- can also occur as a complication following total hip arthroplasty, however any swelling or anatomic change can result in snapping over the greater trochanter because the ITB remains taut throughout range of movement of the hip
- internal type
- snapping is usually a result of the iliopsoas tendon moving over the iliopectineal eminence, the femoral head, the lesser trochanter or the anterior hip capsule
- can also be related to the iliopsoas bursa
- intra-articular type
- snapping can be caused by loose bodies, synovial chondromatosis or idiopathic recurrent subluxation of the hip
- however most usually caused by acetabular labral tears
Snapping hip typically occurs in females ranging from the mid-teens to early forties
- may be a history of trauma but this is usually associated with the intra-articular type of CS
- will present with a painful snapping sensation localized over the greater trochanter in external snapping, or over the anterior hip in internal snapping
- intra-articular lesions present mainly with pain, however, the patient usually describes a clicking rather than a snapping sensation
- patients with external type snapping can demonstrate the tendon snapping over the greater trochanter, either when standing or lying on their side with the affected leg abducted
- the snap can be felt during active flexion of the hip or passive internal and external rotation of the abducted leg
- internal type
- snapping can be demonstrated with the patient supine and by moving the hip from a position of flexion or flexion with abduction, to extension or extension with adduction
Reference:
- Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg 1995; 3: 303-8.
- Provencher MT, Hofmeister EP, Muldoon MP. The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med 2004; 32: 470-6.