3 Types of Snapping Hip Syndrome

3 Types of Snapping Hip Syndrome

People who pop, click, or snap their hips during particular movements have snapping hip syndrome. While usually harmless, the condition can sometimes lead to joint damage and pain.

Snapping hip syndrome originates in one of three ways. The two most common types of snapping hip are internal snapping hip and external snapping hip. These conditions are caused by tendons or muscles being pulled taut over bone and then releasing, creating a snapping sensation.

The third, less common type of snapping hip, called intra-articular snapping hip, is not caused by a tendon or muscle snapping but by a mechanical problem in the hip joint. All three types are explained below.

1. Internal Snapping Hip

The first type of snapping hip occurs when a tendon slides over protruding bony structures at the front of the hip joint, creating tension and then releasing with a “snap.”

Internal hip snapping is typically caused when either:

• The iliopsoas tendon, which connects two inner hip muscles to the femur (thighbone), moves over a protrusion of the pelvic bone called the iliopectineal eminence.
• The rectus femoris, commonly called a quadriceps muscle, moves over the rounded femoral head, commonly known as the “ball” of the hip’s ball-and-socket joint.

Both the iliopsoas tendon and rectus femoris are commonly called hip flexors.

People with internal snapping hip syndrome may experience:

• Hip popping when running; when the hip is extended from a flexed position of more than 90 degrees, such as when rising from a seated position; or when the hip rotates the leg away from the body.
• Hip popping accompanied by a sharp, sudden pain at the front of the hip, deep within the groin.
• Pain that worsens with activity, as repeated irritation causes the tendon to become inflamed.
• Gradual onset of painful symptoms—the pain may have begun as a mild annoyance and worsened over weeks or months.

Internal snapping hip is the most common type of snapping hip. It is associated with painful inflammation of a bursa located at the front of the hip joint. This inflammation is called iliopsoas bursisitis.

2. External Snapping Hip

The second type of snapping hip occurs when a muscle or tendon slides over the knobby bone at the top of the femur (thighbone), called the greater trochanter. This sliding creates tension followed by a release and snapping sensation at the outside of the hip.

External snapping hip is caused when either:

• The iliotibial band (IT band) slides over a rounded protrusion of the femur (thighbone) called the greater tochanter. The IT band is wide strip of fibrous tissue that extends down the outside of the upper leg, from the pelvis to below the knee.
• The gluteus maxiumus muscle slides over the greater tochanter.

External snapping may be a sign that the iliotial band or gluteus maximus is tight.

People with external snapping hip syndrome may notice:

• The snapping typically occurs during hip flexion and extension, such as when running and climbing stairs. Hip snapping may also be noticeable when playing golf or carrying a heavy load, such as groceries or a heavy backpack.
• Hip popping is accompanied by sharp, sudden pain felt at the outside of the hip.
• The hip feels like it is about to pop out its socket when snapping (it is not).
• Pain that worsens with activity, as repeated irritation causes the tendon to become inflamed.
• The popping hip can often be seen as the IT band or gluteus muscle snaps and causes the overlaying skin to shudder.
• Painful symptoms develop gradually; the pain may begin as a mild annoyance and worsen over weeks or months.

External snapping hip syndrome is often associated with painful tenderness at the outside of the hip, which suggests the athlete may have a type of hip bursitis called trochantic bursitis.

This syndrome is also associated with a tight IT band, sometimes called IT band syndrome.

3. Intra-Articular Snapping Hip

A problem within the hip joint itself can cause this third type of snapping hip. Described below are the most common causes of intra-articular snapping hip.

• An acetabular labral tear is an injury to the tough, flexible cartilage that rings the hip socket, like a gasket. A tear can cause a snapping sensation as well as pain in the groin area. One study found acetabular tears accounted for 80% of intra-articular snapping hip cases.²
• An injury to the articular cartilage, which covers bones' surfaces where they articulate, or meet up with one another. This cartilage reduces friction between the bones at the joint, and it can be damaged suddenly from a traumatic injury or over time from arthritis.
• Loose bodies of material in the hip that interrupt the joint’s normal biomechanics and cause a catching or snapping sensation. For example, following a trauma, a fragment of soft tissue or bone can break away and get trapped between the hip’s ball and socket.

Intra-articular snapping hip may develop suddenly, and may caused by a fall or other trauma. It is often accompanied by a catching sensation and/or a limited range of motion in the hip.

People who have snapping hip syndrome with painful symptoms should consult a physician. A medical professional can give an accurate diagnosis and help develop a treatment plan to alleviate pain and minimize possible future joint damage.

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