Treatments of snapping hip syndrome

Physical therapy

Treatment for each patient with snapping hip syndrome should begin with the appropriate physical therapy! Biomechanical assessment of the patient includes both static (posture) and dynamic elements. Particular areas of attention during this portion of the examination include

• knee flexion contracture,
• overpronation of the foot,
• hip flexion contracture, a
• internal or external rotation

Treatment during the acute phase consists of standard anti-inflammatory care and the elimination of activities that exacerbate symptoms.
Ultrasound, phonophoresis, electrical stimulation, iontophoresis can also be used.

Medications

Occasionally, patients may require intermittent Non-steroidal anti Inflammation drugs therapy or simple analgesics as they progress in activities. A corticosteroid injection may be beneficial for those who have persistent pain despite an adequate therapy program.

Surgery

There are several surgical interventions that have been described for patients with persistent pain associated with a snapping hip syndrome. Of course, they should be considered only if the conservative treatment has failed. An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resection of a lesser trochanteric bony ridge, if involved, is described. However, every patient should note that surgical intervention is rarely necessary in the management of this condition.

1. Resection of the posterior half of the iliotibial tract at the insertion site of the gluteus maximus, with excision of the trochanteric bursa.
2. Elliptical resection of a portion of the iliotibial band overlying the greater trochanter, with removal of the trochanteric bursa, can be performed.
3. Z-plasty of the iliotibial band, resulting in lengthening of the tendon, is another option.  
4. A lengthening procedure can be performed on the iliopsoas tendon, typically by partial release of the tendon
5. Resection of the bony prominence of the lesser trochanter.
6. Complete release of the iliopsoas tendon.

Prognosis

This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern. If it is bothersome or painful, stretching of the tight structures can alleviate the symptoms in 6-8 weeks of consistent attention.