Internal snapping hip is a syndrome caused by recurrent subluxation of the iliopsoas tendon. There is little agreement regarding the impinging sites responsible for the jerky motion of the tendon. Thus far, the lesser trochanter, anterior capsule, and iliopectineal eminence are considered the most likely catching sites.
We report an unusual case in which a calcific tendinitis of the rectus femoris direct head impinged against the overlying iliacus muscle, resulting in a painful coxa saltans. The exclusive involvement of the direct head hid the calcium deposit on standard radiographs, whereas MRI suggested but poorly showed the tendon disease. Dynamic ultrasonography and CT scanning allowed a precise diagnosis and subsequent treatment with CT-guided steroid injection.
Calcific tendinitis of the rectus anterior direct head has not been reported as a possible cause of snapping hip; involvement of the direct head in rectus anterior calcific tendinitis was described in one case.
Purposes and Clinical Relevance
Our case shows the rectus anterior direct head may be involved in the etiology of coxa saltans. Theoretically any thickening of the tendon might activate the same pathomechanism. Physicians should consider this possible new cause of internal snapping hip when the most common ones have been excluded, especially as it may be managed easily with steroid injection.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Supplementary material 1Ultrasound dynamic transverse scanning is shown during actively controlled extension of the hip from 60° to 20°. When flexion is approximately 45°, the iliacus muscle splits abruptly in two parts: the main belly moves medially over the iliac spine-calcification complex, while the ilioinfratrochanteric bundle diverges laterally, simultaneously with an audible snap. AIIS = anterior inferior iliac spine; Ca = calcification; IITB = ilioinfratrochanteric bundle; IMB = iliacus main belly. (MPG 6910 kb)
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Pierannunzii, L., Tramontana, F. & Gallazzi, M. Case Report: Calcific Tendinitis of the Rectus Femoris: A Rare Cause of Snapping Hip. Clin Orthop Relat Res 468, 2814–2818 (2010). https://doi.org/10.1007/s11999-009-1208-9
- Steroid Injection
- Groin Pain
- Rectus Femoris
- Direct Head
- Ligamentum Teres