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Coxa Saltans R29.4 719.65

 

synonyms: snapping hip

Coxa Saltans ICD-10

  • R29.4:    Clicking hip

Coxa Saltans ICD-9

  • 719.65 (snapping hip)

Coxa Saltans Etiology / Epidemiology / Natural History

  • External type is most common.
  • Internal type is associated with ballet dancers.

Coxa Saltans Anatomy

  • External snapping hip occurs between the iliotibial band and the greater trochanter.
  • Internal snapping hip occurs between the iliopsoas tendon and the anterior hip capsule (iliopectineal line or femoral head).
  • Other causes: intra-articular loose bodies / labral tears

Coxa Saltans Clincal Evaluation

  • audible soft-tissue snapping, popping, or clicking during hip ROM, with variable associated pain.
  • Internal type is reproduced by extending the hip from a flexed, abducted, and externally rotated position.  With flexion of the hip, the iliopsoas tendon shifts laterally in relation to the center of the femoral head.  With extension of the hip, the iliopsoas tendon shifts medially in relation to the center of the femoral head.
  • External type is reproduced by bringing hip into adduction with knee extension.

Coxa Saltans Xray

  • A/P pelvis, A/P and lateral of affected hip generally normal. May show calcifications near the lesser trochanter.
  • Dynamic ultrasound can confirm the snapping structure in both types.
  • MRI generally indicated to rule out other pathologic conditions.

Coxa Saltans Classification / Treatment

  • Internal type: caused by slipping of the iliopsoas tendon over the iliopectineal line of the pelvis, or the femoral head.  More commonly seen in Ballet Dancers. Treatment: rest, activity modifications, avoidance of snapping, stretching and strengthening of the ioliopsoas and iliotibial band, and NSAIDs.
  • External type: caused by the iliotibial tract or the gluteus maximus sliding over the greater trochanter of the femur. Treatment: rest, activity modifications, avoidance of snapping, stretching and strengthening of the ioliopsoas and iliotibial band, and NSAIDs. Consider release for resistance cases (White RA, AJSM 2004;32:1501).

Coxa Sultans Surgery

  • Indicated only in cases refractory to non-surgical treatment.
  • Internal type: Consider iliopsoas tenotomy vs lengthening (Dobbs MB, JBJS 2002;84A:420), (Gruen GS, AJSM 2002;30:607). Can be done arthroscopically.
  • External type: Consider trochanteric bursectomy vs iliotibial tract Z-plasty. (see White R, AJSM 2004;32:1504).

Coxa Saltans Associated Injuries / Differential Diagnosis

Coxa Saltans Surgical Complications

  • Cutaneous nerve palsy
  • Femoral nerve palsy
  • Infeciton
  • Hematoma

Coxa Saltans Follow-Up Care

Snapping Hip References

  • Allen, W; Cope, R: Coxa Saltans: the Snapping Hip Revisited.  JAAOS. 1995 Vol 3, No. 5, 303-308.

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