Snapping psoas
Young women commonly experience clicking at the front of the hip. This is due to the tendon of the psoas muscle flicking either side of the prominence of the hip joint as it passes from inside of the pelvis to its attachment at the top of the femur. This is usually entirely normal. However an increase in clicking associated with pain may warrant attention as it may indicate other problems in the hip joint such as hip dysplasia or a labral tear. Diagnosis is confirmed with a dynamic ultrasound scan and by excluding other hip conditions with x-ray, MRI and possible CT scan.
Provided there are no other hip conditions, the mainstay of treatment is physiotherapy to stretch the tendon and strengthen the muscles of the hip girdle and core. Occasionally an injection of a cocktail of local anaesthetic and anti-inflammatory steroid into the tendon as it passes over the hip joint is necessary. Very rarely arthroscopic surgical release of the tendon is necessary; this may be done arthroscopically or open determined by the circumstances.
Snapping ilio-tibial band (ITB)
The ilio-tibial band (ITB) is a ribbon of fibrous tissue that originates on the outside of the pelvis and attaches to the outer side of the knee. As it passes over the outside of the hip it may flick in front and behind of the bony prominence (greater trochanter) causing clicking or pain from trochanteric bursitis. The condition is most common in young women. Provided there are no other hip conditions, the mainstay of treatment is physiotherapy to stretch the ITB and strengthen the muscles of the hip girdle and core.
Occasionally an injection of a cocktail of local anaesthetic and anti-inflammatory steroid into the tendon as it passes over the trochanter is necessary. Surgical release of the ITB is very successful but is only occasionally required.