Ultrasound Plus Injection of Anesthetic Helps Relieve Pain of Snapping Hips

A snapping hip can cause deep groin pain, burning in the groin, or a popping/snapping sensation that can be quite painful. It often doesn't respond to conservative treatments like rest, stretching exercises, ultrasound, or anti-inflammatory drugs.

The snapping can be caused by one of three injuries inside the hip. The most common cause is a layer of connective tissue that begins on the outer side of the hip joint and goes down to the shin may catch on the greater trochanter, a spot on the top of the femur that attaches several muscles. A snapping hip can also be caused by tears in the tissue in the hip joint or a tendon may catch and snap across the femoral head.

Researchers have been looking at the most effective way to treat snapping hips, relieving the pain and increasing hip movement and range of motion. One study looked at the results of a 6-8 week program of hip stretching, however, it showed that only 36 percent of the patients improved without having to progress to surgery. Another trial in which patients took part in a 3-month study found that 63 percent of the patients improved with this non-invasive treatment.

Surgery has been the last option for treatment of painful hip snapping and involves tension-release or lengthening of the muscle and tendon. Following surgery, patients have to rest for about 3 months. Surgery introduces the possibility of complications, reportedly in 43 percent to 50 percent of patients. In one study, 12 percent of the patient complications were directly related to the surgical incision itself, and another study showed 11 percent of incision-related complications.

In this study, researchers followed 6 patients who complained of chronic snapping hips and who had previously received at least 6 months of treatment that involved rest, stretching, strengthening, and NSAIDs (non-steroidal anti-inflammatory drugs), but did not experience relief. The study began with 45 patients, but only the 6 who were followed met all the criteria and chose to remain in the study.

All 6 patients' hips were evaluated by magnetic resonance arthrography. To do this, doctors inject liquid into the hip joint and look at images that are made by radio waves. During the procedure, the patients received an anesthetic injection to the hip to see if this would relieve the pain.

When the paint was not relieved, the patients underwent an ultrasound of their affected hip and were given another anesthetic injection, directly into the tissue at the front of the hip, called the psoas bursa. The patients then followed a rehabilitation protocol of using crutches for 5 weeks, gradually increasing weight bearing as the strength of the hip increased.

At 1-year follow-up, all of the patients reported 100 percent relief from pain and that the hip snapping had not returned. Two patients did complain of slight pain occasionally, but they still rated their pain relief at 100 percent. The also agreed that they had no complications from the procedure and that the repaired hip was just as strong as the other.

The authors of the study concluded that using ultrasound to evaluate the location of the injury and to guide the anesthetic injection is a safe outpatient procedure that provides relief from snapping hips.

Reference: 

Mark E. Flanum, MD, et al. Athroscopic Treatment of the Painful "Internal" Snapping Hip: Results of a New Endoscopic Technique and Imaging Protocol. In American Journal of Sports Medicine. May 2007. Vol. 35. Number 5. Pp. 770-779.

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