Is a snapping hip the same as iliotibial band friction syndrome?
A snapping hip occurs when the patient reports a sound or sensations of internal hip clicking with flexion and extension. This may reflect a torn acetabular labrum, or it may occur as the iliopsoas passes over the pelvic brim or as the ITB moves over the greater trochanter. The patient usually does not have pain unless there is an associated bursitis. This usually occurs as a result of a tight ITB (see Ober test later) or muscle imbalance.
The ITB syndrome causes lateral knee pain and is related to irritation and inflammation at the distal portion of the ITB as it courses over the lateral femoral condyle. The Noble test is performed with the patient supine and the knee flexed to 90 degrees. The examiner grasps behind the knee and with their thumb applies pressure to the ITB over the lateral femoral condyle. The ankle is grasped with the other hand and the knee extended. Tenderness at the lateral femoral condyle elicited between 30 degrees and 40 degrees of knee flexion is a positive sign. The Ober test is done by placing the patient on his or her side with the affected leg upward. The injured leg is flexed to 90 degrees at the knee and fully abducted, following which the hip is hyperextended while stabilizing the pelvis. The leg is then slowly lowered as far as possible. Inability of the extremity to drop below horizontal to the level of the table indicates a tight ITB, which is frequently seen in patients with ITB friction syndrome. The ITB syndrome is often caused by running excessively or running hills or on slanted surfaces. Treatment consists of stretching the ITB, ice, modalities, NSAIDs, better training techniques, and rarely corticosteroid injections.