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Purpose The aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure. Methods Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated. Results Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p < 0.001), NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p Conclusions Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined. Level of evidence IV: retrospective comparative trial.

Hip pain is a common and complex clinical entity. The causes of hip injuries in athletes are many and diverse, requiring efficient, accurate diagnosis for proper management. Imaging is an important step in the clinical evaluation of hip pain, and familiarity with multiple imaging modalities as well as characteristic imaging findings is a helpful tool for sports medicine clinicians. This article discusses imaging recommendations and gives imaging examples of common causes of intra-articular and extra-articular hip pain including femoroacetabular impingement, labral tears, cartilage defects, ligamentum teres injuries, snapping hip syndrome, femoral stress injuries, thigh splints, athletic pubalgia, avulsion injuries, and hip dislocation.

The hip joint is the largest weight‐bearing joint in the body and is surrounded by dense capsules and thick muscles. Hip arthroscopic techniques are suitable for the treatment of hip‐related conditions. These minimally invasive techniques have rapidly developed in China since 2007. Moreover, they have been used in the treatment of gluteal muscle contracture, snapping hip syndrome, femoral acetabular impingement, acetabular labral injury, hip labral calcification, synovial chondroma, osteoid osteoma, synovitis, osteonecrosis of the femoral head, and developmental dysplasia of the hip. This technique has showed its advantage in the total debridement of lesions, precision treatment, and less trauma. However, we lack understanding of the overall development of arthroscopic techniques in China. This review illustrates the recent development of hip arthroscopic techniques in China and related research progress., Hip arthroscopic techniques have rapidly developed in China in the last few decades. This review illustrates the recent development of hip arthroscopic techniques in China and related research progress.

This study evaluated the outcomes of arthroscopic surgery for the treatment of external snapping hip at 2- to 10-year follow-ups. Eighteen patients with refractory external snapping hip treated by arthroscopic surgery were enrolled in this prospective study. All patients underwent unsuccessful conservative treatment for more than 3 months before surgery. We made diamond-shaped defects on the iliotibial band and resected peripheral fibrosis tissues for iliotibial band release with an arthroscopic approach. The visual analog scale (VAS), modified Harris hip score and return to previous level of activity were evaluated as functional outcomes. In addition, residual discomfort or the presentation of complications was also investigated. The average follow up period was 7 years. The modified Harris hip score increased from 70.08 preoperatively to 93.14 postoperatively, and the VAS score decreased from 3.67 preoperatively to 1.17 2 weeks after the operation and declined to 0.33 at the last follow-up. Neither recurrence of snaps nor complications were recorded. Two patients complained of a tight sensation with tenderness after exertion. Our clinical outcomes were compatible with those of previous studies, and no long-term complications were noted, even with a relatively longer follow-up period than what was reported in previous studies. Arthroscopic surgery is a safe and effective treatment that can provide promising long-term clinical outcomes for patients with refractory external snapping hip.

Purpose Snapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. When the snap is perceived at the lateral side of the hip, this condition is known as external snapping hip or lateral coxa saltans, which is usually asymptomatic. Snapping hip syndrome (SHS) refers to a painful snap, which is more common in athletes who require increased hip range of motion. The aim of this article is to review the most common endoscopic techniques for the treatment of ESHS, as well as their results and limitations. Methods This is a review of the current literature of endoscopic surgical procedures and of the results of the treatment of external snapping hip syndrome. Results The pathogenesis of SHS is mechanical. The initial treatment attempt is conservative, and usually provides good results. Patients who do not respond to conservative management are candidate for surgery. The endoscopic release of the ilio-tibial band or the endoscopic release of the femoral insertion of the gluteus maximum tendon is the most popular technique. Conclusion Endoscopic techniques provide fewer complications compared to open surgery, a lower recurrence rate and good clinical outcomes. More comparative studies with a longer follow-up are required to adequate evaluate the full role of endoscopic techniques in periarticular hip surgery. Level of evidence Level V.

Snapping hip syndrome, or coxa saltans, can result in significant clinical manifestations in patients including pain and limited mobility. A variety of both intra- and extra-articular pathologies have been implicated in snapping hip, including an anatomic variant known as the bifid iliopsoas tendon which has been briefly described in the literature. We report a case of a bifid iliopsoas tendon leading to internal snapping hip syndrome which was ultimately successfully treated with surgical release, including review of the clinical presentation, pathophysiology, and dynamic sonographic findings.

Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.

Funder: University of Cambridge, Purpose: Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. Methods: A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome. Results: A total of 542 studies were identified, of which 49 articles were included for full text analysis for the scoping review. Peritrochanteric space pathology can be broadly classified into (1) greater trochanteric pain syndrome (GTPS), (2) abductor tears and (3) external snapping hip syndrome. Anatomically, gluteus medius, gluteus minimus and tensor fascia lata work in conjunction to abduct and internally rotate the hip. The anterolateral part of the gluteus medius tendon is more prone to tears due to a thin tendinous portion. Increased acetabular anteversion has also been shown to be associated with gluteal and trochanteric bursitis. In terms of clinical examination, tests which were found to be most useful for assisting in the diagnoses of lateral hip pain were the single-leg stance, resisted external derotation of the hip, hip lag sign and the Trendelenburg’s test. Dynamic ultrasound along with guided injections and MRI scan do assist in differentiating the pathology and confirming the diagnosis in patients presenting with lateral hip pain. Finally, the assessment of baseline psychological impairment is essential in this group of patients to ensure outcomes are optimised. Conclusion: Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. A thorough appreciation of the anatomy of the abductor musculature, specific clinical signs and imaging findings will lead to an appropriate diagnosis being made and management plan instituted. Level of evidence: IV.

Purpose of review This is a comprehensive literature review regarding the pathogenesis, diagnosis, and treatment of snapping hip syndrome (SHS). It covers the diverse etiology of the syndrome and management steps from conservative to more advanced surgical techniques. Recent Findings Recent advances in imaging modalities may help in diagnosing and treating SHS. Additionally, arthroscopic procedures can prove beneficial in treating recalcitrant cases of SHS and have recently gained popularity due to their non-invasive nature. Summary SHS presents as an audible snap due to anatomical structures in the medial thigh compartment and hip. While often asymptomatic, in some instances, the snap is associated with pain. Its etiology can be broadly classified between external SHS and internal SHS, which involve different structures but share similar management strategies. The etiology can be differentiated by imaging and physical exam maneuvers. Treatment is recommended for symptomatic SHS and begins conservatively with physical therapy, rest, and anti-inflammatory medications. Most cases resolve after 6-12 months of conservative management. However, arthroscopic procedures or open surgical management may be indicated for those with persistent pain and symptoms. Different surgical approaches are recommended when treating internal SHS vs. external SHS. Due to advancements in treatment options, symptomatic SHS commonly becomes asymptomatic following intervention.

Introduction: External snapping hip syndrome is characterized by a painful sensation accom­panied by an audible snapping noise in the hip when moving. Even though orthopedists are widely aware of this condition, imaging findings still need to be recognized by all radiologists in order to provide more information that allows for the best multidisciplinary treatment. Z-plasty of the iliotibial band is the most used treatment with the best results.Case presentation: Female patient with bi­lateral external hip snapping syndrome on the right side, who was treated initially in a con­servative manner without adequate response; hence, she required surgical management with arthroscopy. All treatment options used for this patient were not successful, and symptoms recurred.Discussion: The diagnosis of snapping hip syndrome is mainly clinical. However, the con­tribution of diagnostic imaging is important to characterize the structures involved in this nosological process, in order to develop the therapeutic planning and do the follow-up.Conclusion: Knowledge on ultrasound and magnetic resonance findings related to this pathology allows radiologists to identify this syndrome and contribute to a timely treatment.

Sports-related articular and periarticular hip injuries are common in athletes. Knowledge of patient complaints and clinical findings are crucial for adequate interpretation of imaging examinations. However, asymptomatic athletes can present abnormal imaging findings, and clinical presentation of hip injuries may be nonspecific. Therefore, a thorough examination of the hip and surrounding soft tissue images is essential.This review describes the intra-articular pathologies encountered in sports activities including labrum or cartilage lesions, associated or not with femoroacetabular hip impingement syndromes, as well as ligament teres injuries, using magnetic resonance imaging (MRI) or computed tomography arthrography. Different causes of snapping hip syndrome (from intra- and extra-articular origins) are also discussed and illustrated. The extra-articular forms of hip impingement syndromes including ischiofemoral and subspine impingement are depicted with MRI and ultrasound. Diagnostic imaging of bone avulsions, greater trochanteric syndrome, athletic pubalgia, and myotendinous injuries is also described.

Impingement of hip arthroplasty components on soft tissues may adversely affect outcomes. An example is impingement of the cup on the ilio-psoas tendon, which has been reported in 0.4% to 8.3% of patients. Contributors to ilio-psoas tendon impingement (IPTI) can be categorised as anatomic (hypoplastic anterior wall), technical (inadequate anteversion and/or lower inclination, oversized cup, cement in contact with the tendon, and intra-muscular screw), and prosthetic (e.g., aggressive cup design, large-diameter head, resurfacing, and collared femoral prosthesis). IPTI manifests as groin pain, raising diagnostic challenges since this symptom lacks specificity. Physical findings of value for the diagnosis include pain exacerbation during active hip flexion, groin pain upon straight-leg raise to 30°, and/or snapping hip syndrome. Confirmation is then provided by ultrasonography and, most importantly, computed tomography. Once the diagnosis is confirmed, non-operative treatment combining physical therapy and local corticosteroid injections is prescribed. When these measures fail, endoscopic or arthroscopic surgery is generally effective. In patients with major cup malposition, revision of the cup is the preferred option, despite the higher complication rate. When cup position is adequate, ilio-psoas tenotomy can be performed either extra-articularly at the lesser trochanter (by endoscopy) or intra-articularly (by arthroscopy). The arthroscopic technique is more demanding but useful when the diagnosis is in doubt, as it allows examination of the prosthetic bearing surfaces. Both techniques and the risks inherent in each are discussed in detail. Tenotomy, whether performed endoscopically or arthroscopically, promptly provides good outcomes in over 85% of patients, usually with full recovery of hip flexor strength over time. These minimally invasive techniques, while as effective as conventional surgery, are associated with lower morbidity rates.

Introduction: Snapping hip syndrome or “coxa saltans,” sometimes called as dancer’s hip, is seen in balletdancers. It is a condition caused by the movement of tendon or a muscle over a bony eminence in the hip inwhich snapping sound is heard or snapping sensation is felt when a person walks, runs, swing leg aroundor get up from a chair. Snapping Hip Syndrome is just associated with the snapping sound and no suchdiscomfort or pain is felt. Patients chief complaints were Low back pain radiating down her right leg andsometimes a click sound heard in her right hip. Experts estimate that 5 to 10 percent of the population hassnapping hips with no symptoms or pain, and no treatment is necessary. On the other half some individualshas irritating pain which requires treatment or surgery. Diagnosis of External Snapping Hip Syndrome wasconfirmed when detail evaluation of patient was done using Special test - SLUMPS and Straight Leg Raise(SLR) test, Faber’s test and Ober’s test and Harris Hip Score was also noted.Conclusion: This case report provides a comprehensive rehabilitation plan that helped relieve pain, spasm,increase strength and range of motion. Physiotherapy intervention includes stretching of the tighten muscleand purposeful strengthening to decrease pain and disability of patient. Physiotherapy treatment is foundto be best to resolve patient’s chief complaints. Improving the disability and Social skill improvement waschecked by using Lower Extremity Functional Scale (LEFS) and Quality of Life (QOL).

Purpose This cadaveric study aimed at describing the anatomical variations of the iliopsoas complex. Methods The iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers—13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas. Results The presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P Conclusions The results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described. Level of evidence Level V

Disorders of the lateral gluteal tendons are a common cause of lateral hip pain and can be simplified to two primary clinical entities: greater trochanteric pain syndrome (GTPS) and snapping hip syndrome. GTPS, which was traditionally misdiagnosed as trochanteric bursitis, involves the gluteus minimus and medius tendons. Patients will often complain of lateral hip pain that may radiate down the thigh and worsens with pressure over the area. Physical examination may reveal point tenderness over the greater trochanter and a Trendelenburg gait. In addition to the examination, diagnosis can be augmented with magnetic resonance imaging or sonographic evaluation. Treatment options range from physical therapy to injections to surgical repair, with varying levels of success. Meanwhile, external snapping hip syndrome often involves primarily the gluteus maximus tendon and iliotibial band. It is a syndrome of mechanical snapping as these structures slide over the greater trochanter and can also lead to lateral hip pain. The snapping sensation can be reproduced on physical exam and seen directly via dynamic ultrasound examination. While most cases can be adequately treated with physical therapy and occasional corticosteroid injections, effective surgical options also exist and range from open to endoscopic surgeries.

The pelvic, hip, and thigh regions are commonly injured during sport-related activities. Acute injuries can occur due to contact or non-contact mechanisms. Common acute injuries include quadriceps, hamstrings, and adductor muscles’ strains or tears; bony or muscle contusions. While overuse injuries occur after repetitive stress, tissue overload, and faulty mechanics. These include femoral neck stress fractures, femoroacetabular impingement, athletic pubalgia, greater trochanteric pain syndrome, snapping hip syndrome. Early diagnosis leads to proper treatment interventions that can include oral or topical medications, rehabilitation, injections, and surgery when indicated. Finally, the return to sport decision is made after a successful rehabilitation process to ensure the safety and health of the individual.

Classically, external snapping hip syndrome (ESHS) is considered to be caused by friction of a tight iliotibial band (ITB) over the greater trochanter (GT), which leads to pain, inflammation, and palpable or audible snapping. Surgical treatment remains a gold standard in patients resistant to conservative measures. Many surgical procedures addressing ESHS exist in the literature, but the vast majority of them involve only plasties of the ITB. However, observations led us to the conclusion that friction of the ITB over the GT may not be the only cause of ESHS and other structures like gluteal fascias or an anterior scarred part of gluteus maximus may be involved. The aim of this article is to provide a detailed description and video demonstration of an endoscopic surgical procedure using a "fan-like" cut to treat the ESHS. Its greatest advantage is the ability to gradually increase the extent of surgery based on intraoperative observations. It turns the procedure into a tailor-made surgery, which offers good and reproducible results.

The External Snapping Hip Syndrome is characterized by a snapping on the lateral region of the hip. It can be painful or painless associated with audible or palpable snapping which occurs during certain provocative movements. Iliotibial Band, Tendon Fascia Latae, and Gluteas Maximus has been implicated as the involved structure in this form of snapping hip. The goal of treatment is to achieve pain-free functional activities especially in an athlete. This is a case of External Snapping Hip Syndrome presented occurring in a Field Hockey Athlete which was diagnosed clinically and confirmed by Dynamic Ultrasound investigation. The focus of rehabilitation program in this case was a combination of active and passive exercise stretching as the provision of hip guard. This lead to an improve function and safe return to his sports.

Runners frequently experience pain in the hip, pelvis, and thigh. The differential diagnosis is broad, and pain in these regions often presents a diagnostic and therapeutic challenge. Common conditions include muscle strain, proximal hamstring tendinopathy, greater trochanteric pain syndrome, snapping hip syndrome, iliopsoas bursitis/tendonitis, and femoroacetabular impingement. A detailed understanding of potential etiologies as well as performing a detailed history and physical examination is critical to establish a diagnosis and to initiate appropriate treatment. Physical therapy and running gait analysis with retraining are essential in treating hip, pelvic, and thigh pain in the runner. More high-quality and runner-specific research is needed to determine optimal treatments.

Hip injuries in athletes are a relatively common cause for pain. They are estimated to account for approximately 5–6% of all sport injuries. Groin pain is commonly caused by sudden changes in direction, acceleration and deceleration, and sports that involve kicking. It may present as an acute traumatic episode or as chronic pathology which can be often caused by overuse or repetitive trauma. Hip pathology in athletes usually presents as composite pain caused by multiple reasons—multiple diagnoses can be present in up to 90% of patients. The most common problems are adductor muscle strain, hip bursitis, hip contusions (pointer), labral tears, osteitis pubis, femoral neck stress fracture, sports hernia, femoroacetabular impingement (FAI), snapping hip syndrome, and arthritis.

Coxa saltans, or snapping hip syndrome, is a common orthopaedic problem that can easily be diagnosed and treated when the proper evaluation and management are utilized. It is often seen in growing adolescents, athletes, and people with sudden increase in physical activity. A thorough physical examination will help decipher whether the snapping hip is intra-articular or extra-articular and will help guide treatment options. This article reviews how to perform a physical assessment and treatment options such as medications, stretching, physical therapy, articular injections, and possible surgical interventions. Complications from conservative treatments are rare, but weakness, infection, nerve damage, and atrophy may occur following surgical procedures.

Background Studies have reported on the arthroscopic technique for release of external snapping hip syndrome. However, no study with large sample size has been reported for arthroscopic surgery. Methods Patients with 229 bilateral and 19 unilateral external snapping hips were treated from January 2012 to June 2013. After locating the contracture position, arthroscopic surgery was performed accordingly. Preoperative and postoperative angles were compared. Results Comparing range of motion, all patients obtained higher adduction and flexion angles. At postoperative follow-up of 24 months, the adduction angle was improved from −14.4 ± 5.14 to 35.7 ± 4.21 for type I, from −31.2 ± 5.22 to 31.7 ± 2.84 for type II, from −49.0 ± 3.47 to 21.6 ± 3.43 for type III, and from −64.5 ± 4.65 to 18.3 ± 3.10 for type IV (P

Impingement syndromes are increasingly recognised as significant causes of hip pain and dysfunction. A broad spectrum of intraarticular and extraarticular conditions has been implicated in their pathophysiology. Physical examination is often inconclusive as clinical findings may be unclear or misleading, often simulating other disorders. With current improvements in imaging techniques and better understanding of hip impingement related pathomechanisms, these entities can be accurately diagnosed. In addition, preoperative imaging has allowed for targeted treatment planning. This article provides an overview of the various types of hip impingement, including femoroacetabular impingement, ischiofemoral impingement, snapping hip syndrome, greater trochanteric-pelvic and subspine impingement. Current literature data regarding their pathogenesis, clinical manifestation and imaging work-up are discussed.

The snapping hip (SH) syndrome is characterised by an audible snapping, often accompanied by pain, which usually occurs with the flexion and extension of the hip during exercise or ordinary daily activities. The causes of SH can be classified as external, internal and intraarticular. The prevalence of asymptomatic SH in the population is unknown and the incidence of symptomatic cases is not well-defined. The painless snapping in the hip is common in the general population; the symptomatic SH with debilitating pain and weakness is often seen in those who take part in activities such as ballet and running hurdles. The clinician's goal is to determine the cause and treat patients who have symptomatic SH so that they may return to their activities or to athletic peak performance. Most patients with SH can be treated conservatively. However, surgery may be indicated if the condition becomes chronically symptomatic. Arthroscopy may prove useful in the treatment of intraarticular lesions that are causing discomfort. Various techniques have been described with different grades of success. The aim is to achieve the least invasive procedure with the lowest potential complications that corrects the painful snapping, according to the patient's characteristics. The purpose of this systematic review is to clarify the results of the surgical treatment of SH, after the failure of the conservative treatment.

Snapping hip syndrome is a group of well-recognised hip disorders characterised by audible (often palpable) snapping with certain hip movements. There are both intra-articular or extra-articular causes associated; the latter being further subdivided into external causes (iliotibial band and gluteus maximus) and internal causes (iliopsoas tendon). Determining the correct diagnosis is the key to successful treatment. The first line of treatment is typically non-operative, including rest, avoidance of inciting activities, physiotherapy, anti-inflammatories and injections with steroid and local anaesthetics. Recalcitrant cases are treated with surgery.

Hip pain may originate from various structures, but gluteus medius and gluteus minimus tendons, iliotibial band and gluteus maximus, pubic symphysis, and rectus abdominis-adductor aponeuroses pathologies are the primary causes. Static ultrasound may show many anomalies, but dynamic ultrasound, which allows real-time assessment of the relative movements of the structures, is the modality of choice for evaluation snapping hip syndrome.

Introduction: Internal snapping hip syndrome (ISHS) is caused by the iliopsoas tendon snapping over either the iliopectineal ridge or the anterior femoral head. Excellent results are achieved only with activity modification, rest, and stretching the iliopsoas muscle. The literature favors iliopsoas tendon release if conservative therapy fails. There is little evidence about the gold standard of this condition. Objective: Describe clinical results, complicactions and recurrence rate of arthroscopic treatment of ISHS. Methods: We included all patients who failed conservative treatment and were treated with arthroscopy for ISHS between March 2012 and March 2018. Patients with less than 2 years of follow up and previous surgery on the hip were excluded. We performed Ilizariturri´s technique with a transcapsular endoscopic release in central compartment. We registered modified Harris hip score (MHHS), Hip outcome score activity of daily living (EHOSDL), patients satisfaction, recurrence rate and complications. Results: Eight patients were included. Average follow up was 36 months (range 24-60 months). MMHS improved from preoperative average score of 70 (range 62-72) to postoperative average of 93 (range 92 to 96). Average EHOSDL improvement was 30% (from 55% preoperative to 85% postoperative). All patients had excellent results. Average patient satisfaction was 8 (range 7-9). We had no recurrence or complications. Conclusion: Arthroscopic treatment of ISHS allowed us to obtain very good clinical results with no complications or recurrences with a minimum 2 years follow up.

OBJECTIVE. The purpose of this video article is to review the dynamic sonographic assessment of snapping hip syndrome. The video focuses on the extraarticular forms of snapping hip and discusses their possible causes, ultrasound features, and treatment options. The dynamic sonographic technique for evaluating snapping hip syndrome is shown with live scanning videos. CONCLUSION. Dynamic ultrasound is well suited for the assessment of snapping hip syndrome and is essential for confirming the clinical diagnosis of the condition.