yoga book / pathologie / springende hüfte / coxa saltans

Definition

The snapping hip, coxa saltans or Amon’s snapping hip, is present as coxa saltans interna (intra-articular event) or more frequently as coxa saltans externa (extra-articular event), in each case differentiated according to cause. Not all sources seem to use the terms in this way. Coxa saltans externa is painful in less than a third of cases, in which the posterior edge of the iliotibial tract or the anterior edge of the gluteus maximus jumps over the trochanter major, which may be accompanied by bursitis trochanterica (often the end part of a GTPS). The snapping may be visible, patients may trigger it themselves subjectively, (sub)dislocation phenomena are felt. Less than a third of cases are painful. Jumping of the iliotibial tract can be provoked with an extended knee joint and adducted hip joint from hip extension in the direction of flexion. The upper test and noble compression test show a contracted iliotibial tract and tensor faciae latae respectively. In the case of coxa saltans externa, an accompanying or underlying GTPS should be investigated. Depending on the form, synovial inflammation of the bursitis subcutanea trochanterica is possible. The X-ray is usually O.B. The MRI is also often without abnormalities, at best a bursitis trochanterica, changes in tendons, tendon thickening, labrum lesions or paralabral ganglia are shown.

Treatment is started conservatively, according to the recognised or suspected causes; contractures of the gluteus maximus and tensor faciae latae often need to be removed. Local infiltrations can also be carried out. If this therapy fails, surgical intervention is an option, after which sport is avoided for six weeks and the load is increased in a pain-adapted manner. Surgical tract release is also possible. If the problem lies in the iliotibial tract, this can also be fixed to the major trochanter.

Cause

1. extra-articular:
   • Sliding of the tendon of the iliopsoas over the eminentia iliopubica
   • Sliding of the tendon of the iliopsoas over the femoral head altered by an FAI
   • Sliding of the tendon of the iliopsoas through a two-headed iliacus
   • Sliding of the tendon of the biceps femoris (caput longum) over the tuber ischiadicum
   • Sliding of the gluteus maximus over the trochanter major
   • Sliding of the iliofemoral ligament over the hip head
   • Sliding of the iliotibial tract over the trochanter major (proximal ITBS. Cause: foot malalignment, X-legs, hip malalignment)
2. intra-articular:
   • Free joint bodies
   • Labral lesions
   • reversible Subluxationen des Hüftkopfs
   • Osteochondral fractures

Predisposing

1. (no standardised information possible)

Diagnose

1. Clinical
2. Sono
3. MRI, if necessary

Symptome

1. bouncing in the area of the hip joint or trochanter major, which can be perceived by the patient and externally, possibly painful

Therapie

1. depending on the cause, mostly conservative