Endoscopic release of internal snapping hip: a review of literature

Abstract

Background: Internal snapping hip is a common clinical condition, characterized by an audible or palpable snap of the medial compartment of the hip. In most cases it is asymptomatic, while in a few patients, mostly in athletes who participate in activities requiring extremes of hip range of motion, the snap may become painful (internal snapping hip syndrome-ISHS). Materials and methods: This is a review of current literature, focused on the pathogenesis, diagnosis and treatment of ISHS. Conclusion: The pathogenesis of ISHS is multifactorial, and it is traditionally believed to be caused by the tendon snapping over the anterior femoral head or the iliopectineal ridge. Most cases of ISHS resolve with conservative treatment, which includes avoidance of aggravating activities, stretching, and NSAIDs. In recalcitrant cases, surgery may be indicated. Better results have been reported with endoscopic iliopsoas tendon release compared with open techniques, which may be related to the treatment of concomitant intra-articular pathologies. Furthermore, endoscopic treatment showed fewer complications, decreased failure rate and postop erative pain. It is important to remember that in most cases, a multiple iliopsoas tendon may exist, and that the incomplete release of the iliopsoas tendon can be a reason for refractory pain and poor results. Then, even if of not clinical relevance at long term follow-up, patients should be told about the inevitable loss of flexion strength after iliopsoas tenotomy. Level of evidence: II.

Snapping Hip Syndrome

“…In a large series with over 80 patients, 77% of success has been reported by means of partial tenotomies for lengthening the iliopsoas tendon, with only 2.5% of patients requiring a revision surgery 9 . However, open surgery has reported 2 major downsides: complications associated with the open incision and the challenge in simultaneously treating associated intra-articular pathology 69,70 . Open procedures have reported a substantial complication rate, which may be as high as up to 40% of cases 69 .…”

“…However, open surgery has reported 2 major downsides: complications associated with the open incision and the challenge in simultaneously treating associated intra-articular pathology 69,70 . Open procedures have reported a substantial complication rate, which may be as high as up to 40% of cases 69 . Hip flexor weakness after iliopsoas release is the most reported complication, but other issues have also been noted, including heterotopic ossification, persistent hip discomfort, continuing snapping, sensory deficiency of the lateral femoral cutaneous nerve, painful bursae, and infection 9,41,59,71 .…”

“…Concomitant intra-articular pathology with ISHS cannot be treated easily with open lengthening of the iliopsoas tendon 69,70 . For example, femoroacetabular impingement syndrome, labral tears, and cartilage lesions have been widely reported as intra-articular issues associated with ISHS, and most authors have been in favor of arthroscopic surgery for treating those conditions at the same time 16 .…”

Dor na face anterior da anca no adulto

“…O Rx antero-posterior pode ser usado para estudar a anatomia da anca e descartar patologias coexistentes, como anteversão acetabular, coxa vara e displasia, que podem contribuir para a anca de ressalto. A ecografia é mais indicada para o diagnóstico, uma vez que pode documentar o fenómeno de ressalto e a RMN é geralmente usada se suspeita de patologia intrarticular, como rotura do labrum (Battaglia et al, 2016;Via et al, 2016).…”

“…O tratamento conservador é o mais indicado, com recurso a terapêutica farmacológica (para alívio da dor) e não farmacológica (estiramentos, massagens, reeducação neuromuscular); o tratamento cirúrgico pode ser equacionado quando há falência do tratamento conservador e os sintomas se tornam crónicos (Via et al, 2016).…”