Snapping Hip Snapping Hip Syndrome • Painful snap with hip motion Jon A. Jacobson, M.D. • Intraarticular • Extraarticular: Professor of Radiology Director, Division of Musculoskeletal Radiology – Anterior: iliopsoas tendon University of Michigan – Lateral: iliotibial tract or gluteus maximus Iliopsoas Complex Disclosures: • Consultant: Bioclinica • Advisory Board: Philips • Book Royalties: Elsevier AIIS • Not relevant to this talk Ilium Note: all images from the textbook Fundamentals of Musculoskeletal Ultrasound are copyrighted Red: psoas major by Elsevier Inc. Orange: medial iliacus fibers Purple: lateral iliacus fibers From: Guillin R. et al. Eur Rad 2009; 19:995 Snapping Hip Syndrome: iliopsoas Outline: • Image long axis to inguinal ligament superior • Snapping Hip to femoral head – Iliopsoas • Extension of flexed abducted and – Greater trochanter externally rotated hip – Hamstring • Abrupt movement of iliopsoas as iliacus muscle interposed between tendon and bone moves Deslandes et al. AJR 2008; 190:576 1 Snapping Hip Syndrome: iliopsoas Iliopsoas Bursa • Oblique-axial plane: – Superior to femoral head – Lateral to medial – Inject between tendon, ilium1 • Pain relief = successful iliopsoas surgical release2 1Dauffenbach J et al. J Ultrasound Med 2014; 33:405 2Blankenbaker DG. I Skeletal Radiol 2006; Ilium 35: 565 Snapping Hip Syndrome: iliopsoas Snapping Hip: lateral • Transverse over greater trochanter • Hip external rotation / flexion • Abrupt motion of iliotibial tract or gluteus maximus over greater trochanter Snapping Hip Syndrome: bifid iliopsoas Greater Trochanter Yellow arrow = gluteus medius White arrow = Inferior 1 2 gluteus minimus Axial MRI Deslandes et al. AJR 2008; 190:576 3 Superior 4 2 Snapping Gluteus Maximus / Iliotibial Band Trochanteric Iliotibial Gluteus Gluteus Medius Gluteus Band Medius Minimus TFL Region Bursae Gluteus Maximus • Trochanteric: deep to Glut Max gluteus maximus AF LF • Subgluteus medius PF • Subgluteus minimus LF AF: anterior facet • Axial or coronal plane LF: lateral facet PF: posterior facet PF Snapping Gluteus Maximus / Iliotibial Band Snapping Conjoined Long Head Biceps Femoris, Semitendinosus Gluteus Iliotibial Band Medius + Sacrotuberous Ligament TFL Gluteus Maximus Gluteus Maximus Gmin Sacrotuberous Ligament BF-ST Ischium SM From Bierry G et al. Radiology Spencer-Gardner LS et al. PMR 2015; 7:1102 2014;271:162 Snapping Hip Syndrome: iliotibial tract Snapping Hip: take home points Iliotibial Band • Iliopsoas – Entrapment of medial iliacus Gmax • Greater trochanter Gmin – Gluteus maximus and iliotibial tract Gmed 3 Syllabus on line and other educational material: www.jacobsonmskus.com Twitter handle: @jjacobsn 4.