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Return to Sports After Treatment for Snapping Hip Syndrome

Posted on: 12/31/2008
Some athletes are bothered by a painful snapping at the hip when moving the leg from a flexed to an extended position. There can be a variety of reasons why this happens. Some occur outside the joint such as when a tendon rubs over a bony prominence. Others are caused by something going on inside the joint. It could be a tear in the labrum (rim of cartilage around the hip socket) or a loose fragment inside the joint.

Whatever the cause, treatment is needed to help the athlete get back into action. The question the researchers asked in this study was Can athletes with painful snapping hips return to full sports participation after treatment? And in this case, the treatment was arthroscopic release of the iliopsoas tendon.

Fifteen recreational and competitive athletes were treated and tested. All had painful snapping hip syndrome from the iliopsoas tendon rubbing over a bony bump called the iliopectineal eminence. At first, they had conservative care with rest, stretching exercises, and antiinflammatory drugs. Everyone was treated nonoperatively for at least six months.

When that didn't relieve their painful symptoms, they had an ultrasound test to confirm the source of the problem. In about half the cases, they found it was from a snapping of the psoas tendon. In the other half, there was snapping of the tendon seen along with fraying or a tear of the labrum. Then the surgeon injected the iliopsoas bursa with a numbing agent.
When that didn't work, the surgeon performed an arthroscopic release of the iliopsoas tendon. The authors describe the surgery briefly. They make note of the fact that details of the operation (including photos) have been published in a previous article.

The basic procedure cuts the tendon from where it is attached to the lesser trochanter. The lesser trochanter is a bony bump on the upper part of the femur (thigh bone). The surgeon uses a special imaging device called fluoroscopy to see what's going on and make sure of an accurate release of the entire tendon. For those patients with a labral tear (or other soft tissue damage), the surgeon made all necessary repairs of torn tissue.

Afterwards, all the patients were given post-operative instructions about what to expect and how to proceed through rehab. It's normal to have a loss of hip flexion until the tendon reattaches to the surrounding soft tissue structures. This takes about two to four weeks. Until healing takes place, motion and strength are both affected.

Control of the leg and coordination during movement were also impaired. Putting weight on the leg and walking would take some time. They were told not to rush it, but to use crutches or cane(s) until normal movement was restored. Most athletes were able to resume normal motion by the end of 10 weeks. With the help of a physical therapist, they advanced through a sport-specific rehab program. The focus was on regaining normal (pain free) motion and control.

A year after the procedure, all 15 athletes had full motion, full strength, and normal sensation. There were no complications and no limitations in sports participation. This compares favorably with the results of previous studies of patients undergoing a partial release of the iliopsoas tendon. Reports of persistent pain, recurrent tendon snapping, and loss of sensation from cutting through nerves are common after partial release.

The authors conclude that arthroscopic release of the iliopsoas tendon for snapping hip syndrome is safe and effective. The arthroscopic approach reduces complications such as nerve injury and infection that can occur with an open incision.

Arthroscopy also made it possible to identify additional soft tissue damage requiring repair. These tears would not have been observed with open incision techniques. With relief of painful symptoms, athletes were able to return to their previous level of sports participation. Relief of painful snapping was permanent with no cases of recurrence.

Scott A. Anderson, MD, and James S. Keene, MD. Results of Arthroscopic Iliopsoas Tendon Release in Competitive and Recreational Athletes. In The American Journal of Sports Medicine. December 2008. Vol. 36. No. 12. Pp. 2363-2371.

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