Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.C. Campbell and G.D. Paiement
iliopsoas tendon or the iliofemoral ligament that is catching over the
lesser trochanter, anterior aspect of the hip joint, or the superior pubic
ramus. Internal snapping hip may also occur as a result of a poorly positioned
acetabular cup after total hip arthroplasty.
Physical Exam An audible or palpable popping with associated pain
is noted in flexion or in rotation of the hip. Often, the involved tendons
may develop tendonitis and are tender to palpation.
Diagnostic Exams Careful history needs to exclude intra-articular
causes of snapping hip, such as labral tear or a loose body. Snapping hip
relieved by intra-articular steroid injection are often caused by labral
tears [ 19 ]. MRI is commonly employed to look for evidence of tendon
impingement or snapping; edema around or within the tendons may
indicate this. Some authors advocate for the use of dynamic ultrasound
in the diagnosis of snapping hip. The sensitivity and specificity of this is
operator dependent and may not be available at all institutions.
Differential Intra- articular anesthetic and steroid injections are an
excellent diagnostic tool to differentiate intra-articular causes of snapping
hip from extra-articular causes. If pain resolves with intra-articular
injection, then the pain is likely of intra- articular origin.
Appropriate Treatment/Referral The mainstay of treatment for both
internal and external snapping hip is physical therapy and NSAIDs
combined with activity modification. Among patients resistant to this
treatment, tendon lengthening or tendon release has been shown to
improve symptoms. For snapping hip of intra-articular cause, referral
to an orthopedic surgeon is appropriate .
Lateral Femoral Cutaneous Neuralgia
Presentation Lateral femoral cutaneous nerve pain, also known as
“meralgia paresthetica ,” presents with an uncomfortable, numb, and/or
painful sensation in the anterolateral upper thigh. It is reported to be
more common among the obese and diabetic patient groups. It also may
present during pregnancy and with hypothyroidism due to the associated
peripheral edema [ 20 ]. The cause of symptoms is theorized to be the
pannus direct compression of the nerve, either due to a pannus or
entrapment by the inguinal ligament as the nerve crosses under or
through it. Additionally, this condition may occur as a result of hip
replacement performed through an anterior approach or anterior iliac
crest bone grafting, where the lateral femoral cutaneous nerve may be