Hip
Instability
Description
Snapping hip syndrome is the name for a condition that produces an audible “pop” or “snap” in or around the hip joint. Internal snapping hip is associated with the iliopsoas tendon. External snapping hip is associated with the iliotibial band (IT band).
What are the causes?
Internal snapping hip is caused by the iliopsoas crossing over the femoral head (“ball”) of the ball and socket joint. External snapping hip is caused by the IT band crossing over the greater trochanter.
What are the symptoms?
Internal and external snapping hip cause pain and inflammation associated with repetitive friction over their respective bony prominences. The “pop” or “snap” can be heard and felt by both the surgeon and the patient. Symptoms may get worse with increased activity.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam with X-rays. During the exam, your surgeon will move the hip through a range of motion to test for positions that may elicit the “pop” or “snap”. X-rays are usually normal. MRI may show inflammation around the structure associated with the “pop” or “snap”.
How is it treated?
Non-operative
Your surgeon may prescribe anti-inflammatory medication, physical therapy, cryotherapy and activity modification to decrease pain and inflammation associated with the “pop” or “snap”.
Operative
Patients that fail non-operative treatment should consider minimally-invasive arthroscopic or open incision surgery to release the tissue causing the pain. Arthroscopic release of either the iliopsoas or the IT band typically results in resolution of symptoms. Postoperative medication and physical therapy are at your surgeon’s discretion.
Description
A dislocation occurs when the femoral head (ball) no longer sits in the acetabulum (socket). A hip subluxation occurs when the ball comes part of the way out of the socket and then returns without intervention. The ball can be disassociated from the socket in the front or back (more common) of the hip. Hip dislocation is a medical emergency, as the nerves and blood supply to the hip can be injured at the time of injury.
What are the causes?
Hip dislocation occurs from trauma (like falling, collisions during sports or from a motor vehicle accident), with or without abnormal laxity of the hip. Because of the depth of the socket, hip dislocation is uncommon and is often associated with fractures of the femur (thigh bone) or acetabulum (socket).
What are the symptoms?
Hip dislocation causes immediate pain and patients feel the hip “pop” out. Patients cannot walk after hip dislocation. Numbness, tingling and a cold sensation may be felt if the nerves and blood vessels are compromised during the injury.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, aided by X-rays. Range of motion will be greatly reduced, and the hip will have a visible deformity. X-rays will show the dislocated “ball and socket” joint.
How is it treated?
Non-operative
Your surgeon will immediately place the ball back in the socket (reduce the hip) with or without pain medication. After the hip is back in place, further diagnostic studies (CT/”CAT” scan, MRI, Blood Flow) will be performed to assess the extent of the damage to the joint and surrounding structures. If the hip remains stable, your surgeon may prescribe medication and physical therapy.
Operative
Surgery is recommended when the hip cannot be reduced, when a fracture is present or if there are bone fragments in the joint from the injury. Postoperative medication and physical therapy are at your surgeon’s discretion.
Description
Instability refers to laxity in the “ball and socket” joint. Instability can occur for several reasons. The severity and the direction of instability depend on the causal pathology.
What are the causes?
Instability may result from an injury or previous surgery, causing damage to the ligaments or labrum surrounding the joint. It may also be inherited and result from a genetic disease known to cause loose joints like Ehlers Danlos Syndrome or Marfan Syndrome.
What are the symptoms?
Instability causes pain and inflammation associated ith excessive motion of the “ball” in the “socket”. Patients complain of “looseness” or anxiety because their hip feels unstable. Clicking and grinding may occur, as well as weakness depending on the underlying cause of the instability.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam with X-rays. During the exam, your surgeon will move the hip through a range of motion to test for instability in all planes. X-rays may or may not show evidence of instability.
How is it treated?
Non-operative
Treatment depends on the cause of the instability. Your surgeon may prescribe anti-inflammatory medication, physical therapy, cryotherapy and activity modification to decrease pain and inflammation associated with instability.
Operative
Patients that fail non-operative treatment should consider minimally-invasive arthroscopic or open incision surgery to repair the soft tissue surrounding the joint. Postoperative medication and physical therapy are at your surgeon’s discretion.
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