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Snapping Hip Syndrome

Management Team

Snapping Hip Syndrome

Overview

Snapping hip syndrome (SHS) is a clinical condition characterised by an audible or palpable snapping sensation that is felt or heard in the hip during movement.

Snapping: This can occur in different areas of the hip (the outer part of the hip (internal SHS) or the region where the ball of the thigh bone (femur) connects with the pelvic socket (external SHS)); the tendons or muscles slide over bony areas in the hip, causing a ‘snapping’ or ‘popping’ sensation.

The underlying cause of SHS depends on the type of SHS that patients have. Internal SHS occurs due to one or more of the following causes:

  • The iliopsoas tendon (which connects the muscles in the inner hip to the femur) slides over the pelvic bone.
  • The thigh muscle (quadriceps) slides over the ball of the femur.

External SHS occurs when the band of thick fibrous tissue that traverses the outside of the thigh from the hip down to the knee (the iliotibial band) slides over the top of the femur.

  • Tightness in the muscles and tendons surrounding the hip: This can cause friction, leading to snapping.
  • Sports and/or intense physical activities: Engaging in sports or activities that involve repetitive bending at the hip, such as dancing or cycling, can increase the risk of developing this condition.
  • Trauma to the hip joint/hip joint cartilage injuries.
  • Presence of broken fragments of bones/tissues, which are lodged within the ball-and-socket joint of the hip.

  • Pain, inflammation, and/or swelling of the hip
  • A sensation of ‘instability’ in the hip joint
  • Weakness in the leg muscles
  • Difficulties in performing regular physical activities that involve the use of the legs

  • Collection of medical history and detailed evaluation of symptoms
  • Physical examinations to ascertain hip mobility
  • Diagnostic imaging tests (X-ray and/or MRI): these tests enable the specialists to get a clear view of the hip joint and help them rule out other hip conditions (hip arthritis/synovitis or tumours)

Non-surgical treatment

  • Rest and ice: Reducing activity and applying ice can help reduce inflammation and pain.
  • NSAIDs: Over-the-counter anti-inflammatory drugs can help manage pain and swelling.
  • Activity modification: Adjusting exercises or sports activities, such as reducing cycling or swimming with only arm movement, can prevent further strain on the hip.

Surgical treatment

  • Hip arthroscopy: A minimally invasive procedure using a camera to remove or repair damaged tissue causing the snapping.
  • Open surgery: If necessary, a more invasive surgery may be done to directly repair the hip joint.

Post-surgical treatment

After the surgery, proper physical therapy for strengthening the hip muscles is usually recommended. It helps enhance mobility, and gradually ease the patients back into their daily activities.

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Scoliosis

Management Team

Scoliosis

Overview

Scoliosis is an abnormal outward deviation of the spine. The most common age group to be affected is the paediatric population. The types of scoliosis include:

  • Congenital scoliosis, which arises soon after birth.
  • Juvenile scoliosis is detected between the ages of 4 and 10 years.
  • Adolescent idiopathic scoliosis (AIS) occurs after 10 years of age.

  • Scoliosis is a painless disorder. It usually does not cause any neurological symptoms.
  • Early onset scoliosis causes underdevelopment of lungs and heart function.
  • Patients with AIS are usually concerned about their appearance with no other significant complaints.

  • A thorough clinical examination to measure the magnitude of deformity, rule out the causes of deformity, and look for clinical signs of nerve tissue involvement.
  • Spine X-ray to demonstrate the apex of deformity and its magnitude and analyse any bony abnormality of the spine.
  • Spinal MRI to determine the status of the neural tissue. Further investigations would vary according to each patient.

Non-surgical treatment

Bracing is recommended for treating scoliosis in children with early-stage disease with mild deformity.

Surgical treatment

This involves correcting the deformity using screws and rods. This is also done as a palliative procedure to decrease the compression on important structures like the lungs.

  • This complex procedure is usually carried out by an expert team, including a spine surgeon, an anaesthetist, a physician, and a physiotherapist.
  • Highly skilled surgeons with extensive experience are needed to achieve favourable outcomes.
  • Rehabilitation post-surgery is crucial to provide excellent results.
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Sciatica

Management Team

Sciatica

Overview

Sciatica is a symptom of pain radiating down from the lower back to buttock, thigh, calf, and foot. It is a sharp shooting pain that is aggravated with activity and relieved with rest.

  • Adult age group
  • Heavy weightlifting
  • Heavy labour activity
  • Obesity
  • Poor posture
  • Trauma

  • Pain radiating down the leg and is associated with tingling and numbness.
  • Some patients may develop weakness in the muscles of their legs.
  • Sometimes severe nerve compression may cause retention of urine and numbness in the perineal region.

  • A thorough clinical examination to rule out all possible causes of sciatica and ensure that the pain is not being referred from any adjacent joint.
  • A comprehensive clinical neurological examination to rule out any pinch on the nerve tissue.
  • X-ray of the lower back to identify abnormal findings. This would also rule out any fractures, malalignment, or abnormal soft tissue shadows.
  • Spinal magnetic resonance imaging (MRI) to locate the site of disc prolapse and confirm the diagnosis.

Non-surgical treatment

  • Most of the patients get relief with analgesics and rest.
  • Some patients may require epidural injections for spine pain management. This is done by the treating physician or a pain management specialist.

Surgical treatment

  • Patients who do not improve or those who present with severe symptoms require surgery.
  • The surgery aims to reduce the compression on the spinal nerves and alleviate patient symptoms.

  • Avascular necrosis of the femoral head: Decrease in blood supply due to slippage of the head (ball part).
  • Chondrolysis: This is a rare but serious complication where the head of the femur (ball part) is resorbed.
  • Impingement: The hip movements are affected due to abnormal positioning of the femoral head.
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Slipped Capital Femoral Epiphysis

Management Team

Slipped Capital Femoral Epiphysis

Overview

Slipped capital femoral epiphysis (SCFE) is a condition primarily affecting adolescents in whom the femoral head (ball part of the hip bone) moves in a backward direction relative to the neck of the femur (thigh bone) because of the damage in the growth plate.

SCFE can be stable (the child can walk with or without crutches) or unstable (the child cannot put the body weight on the affected side).

  • Obesity and male sex (commonly observed in obese male teens).
  • Hormonal issues (such as thyroid disorders) and kidney disease.
  • Use of steroids.

  • Stable SCFE:
    • Difficulty in walking (the patient walks with toes pointing outwards).
    • Associated intermittent pain in the hip/groin or even in the knee of the affected side, which especially increases after walking/exertion.
  • Unstable SCFE: This is a more severe form of disease in which there is:
    • Sudden onset of pain after an episode of a recent fall.
    • The child is not able to walk without support.
    • The leg is externally (outwards) rotated.
    • There is a limb length discrepancy (the affected leg is shorter than the unaffected leg).
    • Occasionally, there could be bilateral (both sides) involvement in different stages.

  • Clinical tests may reveal pain around the hip region and limitation of the internal (inner) rotation of the hip.
  • X-rays are usually taken from two different angles and are sufficient to diagnose SCFE.
  • Magnetic resonance imaging (MRI) is beneficial in early cases when the X-rays cannot diagnose the disease.

Non-surgical treatment

This is usually helpful during the initial phase of the disease. This comprises:

  • Strict non-weight bearing on the affected side and rest.
  • Obesity treatment for children, if needed.
  • In fewer cases, the application of a hip spica cast (plaster) to immobilise the hip joint.

Surgery

This is advised when the non-surgical treatment fails and is usually done under general or spinal anaesthesia based on the general condition of the patients and their preferences.

  • In-situ fixation: The physician inserts 1–2 screws to prevent further slippage. Sometimes, the surgery is advisable on the opposite side as a prophylactic measure.
  • Open reduction: This is usually required for patients with a severe form of the disease (unstable SCFE) when closed reduction and screw fixation are not possible.

After surgery

To regain paediatric bone health, the patient is allowed weight bearing on the affected side after a couple of weeks and return to sports is permitted after 4–6 months depending on the recovery.

  • Avascular necrosis of the femoral head: Decrease in blood supply due to slippage of the head (ball part).
  • Chondrolysis: This is a rare but serious complication where the head of the femur (ball part) is resorbed.
  • Impingement: The hip movements are affected due to abnormal positioning of the femoral head.
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