Crackling hip syndrome

Hip joint anatomy

To better understand the essence of the problem, you should briefly get acquainted with the structure of the hip joint itself (from Latin Articulatio coxae). It is made of the femoral head and the pelvic acetabulum. The head of the bone is "immersed" in the acetabulum. It is a relatively mobile joint, therefore it is classified as a free spherical joint, similar to the shoulder joint. The possible movements in the hip are: flexion, extension, abduction, abduction, inversion and conversion (or rotations) and the resultant of all these movements, i.e. circumference (circular movements in the joint). In addition to bone elements and ligaments, muscles that allow movement are important.Zginanie (ruch w stronę głowy) - głównie mięsień biodrowo- lędźwiowy i mięsień prosty uda,

Straightening (movement of the lower limb backwards) - mainly gluteal muscles - large, small and medium,

Adduction (movement of the lower limb towards itself) - adductor muscles,

Abduction (movement of the lower limb from one another) - mainly the middle gluteus muscle and the tensioner of the broad fascia,

External rotation of the thigh - active mainly the gluteal muscles (large, small, medium) and the pear-shaped muscle,

Internal rotation of the thigh - actinus great adductor, semimembrane and gluteal small muscle.

It is a pond that carries very high loads when walking, running and playing sports. The signal that there is "something wrong" in the joint is initially pain and contracture in the surrounding muscles. The tension of these structures and fascia causes discomfort and often pain during movements, while abnormal movements are a short path to faster progression of degenerative changes in the hip joint. It should be remembered that the organism is a coherent whole and the dysfunction of one "element" will translate into worse functioning of others, i.e. the so-called compensations. Hence, pains of the entire lower limb and even the entire half of the body may be coupled with the slamming hip.

What is a snapping hip?

Crackling hip syndrome occurs when, during movement, you can hear and feel distinct crackles, jumps and friction in the hip area. They are caused by the friction of soft structures against bone structures, as mentioned earlier. Put simply, our tense muscles rub against bone parts, which causes pain and discomfort. It is a very common dysfunction, mostly among young people (most often between 15 and 40 years of age), who constitute 10-20 percent of the entire society. The causes of this disorder are not fully known, but the most common are overloads related to physical activity (athletics, weight lifting), post-traumatic and as a result of posture defects, and at the same time shortening of one limb or incorrect positioning of the pelvis. Generally speaking, the "culprits" are excessively tense muscles - mainly the iliopsoas and the tension of the broad fascia along with the entire iliotibial band, which disrupt the biomechanics of the hip joint, leading to incorrect movement habits.

Due to the cause, three forms of clicking hip syndrome have been distinguished:

• outside,
• inside,
• intra-articular.

The first one, i.e. the outer one, is caused by friction and too firm support of the iliotibial band (a thick strip of connective tissue on the lateral side of the thigh) against the greater trochanter of the femur (the bone prominence is easily felt under the skin on the upper-lateral side of the femur). By the way, there is also inflammation of the synovial bursa in this area. The pain is located on the lateral side of the hip (above and below the trochanter, and often radiates down to the knee) and is often the domain of cyclists and runners.

The second, or inner, muscle also affects the hip muscle, but this time, which, as mentioned earlier, bends the hip joint. It is located inside and is not easily felt, it extends between the lumbar spine and the femur. Its tension causes a collision and friction with the lesser trochanter of the femur, the femoral head, and the iliopulmonary eminence. Patients then feel pain in the groin.

The last and least common cause of a slamming hip is dysfunction inside the joint. The pathology may concern the labrum, i.e. a kind of shock absorber in the pelvic socket, articular cartilage or some free body, as well as the ligament. Often, such a condition is preceded by a hip joint injury. In this case, pain is the most bothersome and patients report it within the entire lower limb.

In summary, the main symptoms of SHS are:

- crackles and jumping inside the hip, near the greater trochanter of the femur and in the groin,
- pain and discomfort in this area during walking and physical activity, as well as after their completion, as a result of overloading periarticular and articular structures,
- in a later stage, inability to move or severe problems with this activity.
 

Hip shooting syndrome diagnosis

As soon as possible, you should contact a specialist doctor first, preferably in the field of orthopedics and traumatology, so that he can diagnose the problem. SHS is diagnosed on the basis of X-rays, where the absence of bone changes confirms the diagnosis. Such nonspecific pains may occur in many diseases, it may be, for example, a previous bone fracture, osteoarthritis of the hip joints, discopathy / degenerative changes in the lumbar spine, posture defects, etc. We should also remember that a shooting hip may coexist with other diseases . Then, laboratory tests are performed, which show, for example, inflammation in the body, it may occur in rheumatic diseases. Another element is a very thorough interview and physical examination. The doctor tests the joint to cause possible symptoms in certain positions. An ultrasound of the hip is also useful to see "from the inside" if needed patient be referred for physical therapy, which is conservative treatment, or popping hip arthroscopy, which is surgery.

Surgical treatment - popping hip arthroscopy

Arthroscopy or endoscopy of a joint can be both a diagnostic and a surgical procedure to "fix" something. It has many advantages and a great advantage over classic surgical techniques: the incision and thus the postoperative scar is much smaller, the patient undergoes rehabilitation faster and his stay in the hospital is shorter. As with any surgery, arthroscopy can cause complications, such as nerve damage, but they are extremely rare. In hip crackling syndrome, this procedure is used to release the iliopsoas muscle that rubs against the bone structures of the hip joint. This is the previously mentioned intra-articular form of SHS. During the procedure, the patient is usually under general anesthesia, i.e. he is not conscious during the procedure.

What after hip arthroscopy?

The patient undergoes postoperative rehabilitation practically immediately, under the supervision of a physiotherapist. On the 1-2 day after the surgery, the patient performs isometric and anticoagulant exercises, i.e. exercises that will stimulate blood flow in the limbs, as well as gentle stretching exercises to prevent contractures and the patient is upright. For about 2-3 weeks, the patient moves with the help of elbow crutches with a load on the operated limb. It should be remembered that the operated leg must always be in contact with the ground, it never rises when walking on crutches, due to the flow of information from the receptors to the brain.

After leaving the hospital, rehabilitation consists in regaining full mobility in the joint, reducing pain and rebuilding the muscle strength of weakened muscles. There are also manual therapy in the form of deep massage and auxiliary kinesiotaping. In the following weeks, balance, stabilization and stimulating deep feeling exercises are introduced. All listed procedures take approximately 6 weeks. Then patients can slowly return to light physical activity. Return to sport is possible no sooner than 12 weeks after the surgery. The patient should be well prepared to take up the activity, otherwise injuries may occur quickly.

Conservative treatment of clicking hip syndrome

Nonsurgical management involves the use of pharmacological treatment and physiotherapy. In the event of pain and possible inflammation, e.g. bursitis, non-steroidal anti-inflammatory drugs, so-called NSAIDs, e.g. ketoprofen, naproxen, diclofenac are used. Sometimes I use injection or steroid injections.

Physiotherapy consists in re-educating the patient, i.e. correcting movement errors when walking, running and improving the sports technique so as not to overload the joint. Manual therapy techniques are used, e.g. fascia therapy, deep tissue massage and individually selected exercises. Useful, for example, is the PNF method, kinetic control, etc. Kinesiology taping, i.e. elastic tapes relieving, loosening and analgesic, is used to support the therapy, depending on the method of sticking. As an auxiliary, physical therapy procedures are performed, for example, a shock wave (a mechanical wave aimed at "breaking" the tissues and stimulating them to rebuild them properly), cryotherapy, laser therapy. The aforementioned anti-inflammatory drugs are also administered in the form of iontophoresis, i.e. a physiotherapeutic treatment that involves the introduction of a substance (ointment) under the skin with the use of direct current. In order for the patient to have continuous therapy, it is recommended to stretch, i.e. stretch the muscles, and roll, i.e. self-massage the contracted tissues on special rollers. Changes in training habits and more varied physical activities that do not cause overload are also suggested. Properly selected sports footwear is also very important, which is of great importance for the biomechanics of our body during sports.

Frequently asked questions about clicking hip syndrome: