Physio Professionals Newsletter March 2013
this issue P.1&2
P ro f e ssi o n a l D e ve l o p me n t Physio Professionals prides itself in its continuing staff education initiatives.
SNAPPING HIP transient subluxation of the femoral head. Presence of these conditions may cause great discomfort and the patient will most likely have a history of trauma or repetitive overload of the hip.
Michelle Crew (nee: Peauril) Masters of Physiotherapy Level 3 Sports Physio AIS MAPA
Andy Magill B.Sc. Physiotherapy (Hons) Level 1 Sports Physio (Qld) MAPA
Andrew Crew Remedial/Sports Massage Performance Bike Fit Accredited Track and Field / Cycling Coach
“Snapping hip” is a general term used to describe a condition whereby a patient presents with a palpable or audible click that is reproduced with combined movement of the hip (flexion, abduction and external rotation) and depending on the cause, may or may not be painful.
Internal derangement can be challenging to diagnose, for example with loose bodies clicking may only be felt intermittently due to movement of bodies within the synovial recess. Gold standard assessment to rule out internal derangement involves a thorough physical examination in addition to MRI imaging. In the average patient that presents to Medical or Physiotherapy practice, extraarticular snapping hip is more common, and this can be divided into external and internal snapping hip.
Injuries to the hip and pelvis represent roughly 5% of athletic injuries. On average more females develop snapping hip, especially during adolescence, and in the sporting population is it very common in runners, dancers and soccer players. Intra-articular causes may be attributed to loose bodies, acetabular labral tears, osteochondral fractures, synovial osteochondromatosis and
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External snapping hip is caused by movement of the Ilio-Tibial Band (ITB) over the Greater Trochanter. This can be possible to palpate during physical examination with movement of the hip through range. The gluteus maximus and tensor fascia lata muscles both have an attachment to the ITB, chronic tightness or weakness in these muscles contract the ITB and therefore cause it to get “stuck” as it passes over the greater trochanter.
MRI can detect hyper-intensity of involved tendons and dynamic Ultrasound can be used consistently to visualise internal and external snapping as it occurs.
Differential diagnosis would seek to rule out trochanteric bursitis, however, if the snapping is chronic, bursitis is more likely to present in combination. Research on surgical management for snapping hip varies. In one large study of internal snapping, 85 patients underwent open fractional lengthening of the iliopsoas tendon. Eleven continued to snap at 3 months postoperatively, and 9 had snapping return after 3 months. Long term hip flexor weakness is a common complication following surgery. Evidence for conservative management is a little more robust, with one study reporting that between 36% and 67% of patients diagnosed with snapping hip had reduction or resolution of symptoms with conservative management. Internal snapping hip may be attributed to movement of the iliopsoas tendon over the anterior surface and capsule of the femoral head, or alternatively over the iliopectineal eminence of the pelvic rim. Presentation follows the same principles as outlined above, involving psoas major and iliacus muscles. Due to the location of symptoms in the groin, differential diagnosis would aim to rule out any intra-articular causes.
Conservative management of the acute condition starts with rest from aggravating activities in combination with anti-inflammatory medication. The second phase of rehabilitation aims to address the causative factors, this will involve stretching shortened soft tissues, strengthening weak muscles and reviewing athletic/working technique. As symptoms resolve, patients are slowly re-introduced to activities and training/working loads are slowly increased to pre-injury levels. Shop 27 “CENTREPOINT PLAZA” Cnr Minchinton St & Leeding Tce Caloundra Qld 4551
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