Extraarticular Snapping Hip
Sonographic Findings
Vincent Pelsser1,
Étienne Cardinal1,
Roger Hobden2,
Benoit Aubin1 and
Michel Lafortune1
1
Department of Diagnostic Radiology, CHUM-St-Luc Hospital, 1058 Saint-Denis
St., Montreal, Quebec, H2X 3J4 Canada.
2
Department of Family Medicine, University of Montreal, 3590, Ontario St. East,
Rm. 102, Montreal, Quebec, H1W 1R7 Canada.
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Fig. 1. —Diagram shows transverse section of right hip. Note
relationship among iliopsoas tendon, iliotibial band, and surrounding
structures.
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Fig. 2A. —Diagram illustrating "pathomechanics" of snapping
iliopsoas tendon. As hip is flexed, abducted, and externally rotated,
iliopsoas tendon moves laterally with regard to iliopectineal eminence.
Transducer may be placed either on transverse over hip joint (A) or oblique
transverse over pelvic rim (B) to accommodate movement of hip.
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Fig. 2B. —Diagram illustrating "pathomechanics" of snapping
iliopsoas tendon. When hip is moved back toward complete extension, tendon
impinges on iliopectineal eminence. As extension continues, tendon at some
point is released from impingement, moving abruptly medially. This abrupt
abnormal tendon motion is characteristic of snapping hip.
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Fig. 3A. —18-year-old woman with asymptomatic normal right hip.
Transverse (A) and longitudinal (B) sonograms show
hyperechogenic iliopsoas tendon (arrows) and hyperechogenic margins
of acetabulum (A) and femoral head (F). Note overlying hypoechogenic cartilage
(c). Also note fibrillary appearance of iliopsoas tendon on B.
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Fig. 3B. —18-year-old woman with asymptomatic normal right hip.
Transverse (A) and longitudinal (B) sonograms show
hyperechogenic iliopsoas tendon (arrows) and hyperechogenic margins
of acetabulum (A) and femoral head (F). Note overlying hypoechogenic cartilage
(c). Also note fibrillary appearance of iliopsoas tendon on B.
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Fig. 4. —12-year-old girl with iliopsoas tendinopathy of left hip.
Split image with transverse sonograms of right (on left) and left (on right)
hips. Left iliopsoas tendon (right arrow) is hypoechogenic compared
with normal right hyperechogenic iliopsoas tendon (left arrow). A =
acetabulum; F = femoral head.
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Fig. 5A. —27-year-old woman with normal iliopsoas tendon motion.
Transverse sonogram of right hip shows normal, oval-shaped, hyperechogenic
iliopsoas tendon anterior to acetabulum (A) and femoral head (F). As hip is
flexed, abducted, and externally rotated, iliopsoas tendon moves laterally in
direction indicated by arrow. Lateral displacement of tendon is smooth with
mild rotatory motion (counterclockwise for right hip).
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Fig. 5B. —27-year-old woman with normal iliopsoas tendon motion. As hip
is moved back to complete extension, iliopsoas tendon smoothly glides back
medially in direction shown by arrow. There is mild rotatory motion of tendon
(clockwise for right hip). A = acetabulum; F = femoral head.
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Fig. 6A. —15-year-old girl with right snapping iliopsoas tendon.
Oblique transverse sonograms just above coxofemoral joint during video
recording of right hip motion show changes in iliopsoas tendon after snapping
has occurred. Iliopsoas tendon (straight arrow) is anterior to pelvic
bone (curved arrows). Flexed and abducted hip is moved toward
extension and rotated from external position (A) to more internal
position (B). During motion, tendon suddenly displays abrupt abnormal
displacement getting suddenly closer to pelvic bone and change in its shape
(from round in A to ovoid in B), which are correlated with
painful snap felt by patient.
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Fig. 6B. —15-year-old girl with right snapping iliopsoas tendon.
Oblique transverse sonograms just above coxofemoral joint during video
recording of right hip motion show changes in iliopsoas tendon after snapping
has occurred. Iliopsoas tendon (straight arrow) is anterior to pelvic
bone (curved arrows). Flexed and abducted hip is moved toward
extension and rotated from external position (A) to more internal
position (B). During motion, tendon suddenly displays abrupt abnormal
displacement getting suddenly closer to pelvic bone and change in its shape
(from round in A to ovoid in B), which are correlated with
painful snap felt by patient.
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Fig. 7A. —36-year-old man with snapping iliotibial band of left hip.
Transverse sonograms at level of left greater trochanter (T) as patient is
lying on right side. When hip is flexed (A), iliotibial band
(arrows) presents as stripe overlying trochanter. During extension of
hip (B), abrupt displacement of iliotibial band (arrows)
occurs as it gets closer to trochanter and coincides with snap.
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Fig. 7B. —36-year-old man with snapping iliotibial band of left hip.
Transverse sonograms at level of left greater trochanter (T) as patient is
lying on right side. When hip is flexed (A), iliotibial band
(arrows) presents as stripe overlying trochanter. During extension of
hip (B), abrupt displacement of iliotibial band (arrows)
occurs as it gets closer to trochanter and coincides with snap.
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