FIGURE 3.22. Forced flexion combined with internal rotation is often very uncomfortable and usually elicits symptoms associated with even subtle degrees of hip pathology.
Various maneuvers may create a click or popping sensation, which may reflect an unstable labral tear or chondral fragment. However, the origin of these clicks or pops is often unclear, and they do not uniformly reflect an intraarticular lesion.
Snapping of the iliopsoas tendon is a common condition that occasionally can be difficult to distinguish from an intraarticular problem. The characteristic maneuver for creating this type of snap is bringing the hip from a flexed, abducted, externally rotated position into extension with internal rotation.5,6 The snapping occurs as the iliopsoas tendon transiently lodges on the anterior aspect of the hip capsule or pectineal eminence. Although it is important not to misinterpret snapping of the iliopsoas tendon as an intraarticu-lar problem, it is likely that numerous intraarticular disorders get misdiagnosed as a snapping hip syndrome. For recalcitrant cases, snapping due to the iliopsoas tendon can often be substantiated by reproducing the snap under fluoroscopy with iliopsoas bursography. Ultrasound is another method for inspecting the iliopsoas tendon that may be advantageous because producing the snap is less encumbered by the overlying fluoros-copy unit, it is noninvasive, and the contralateral side can be examined for comparison.
Snapping due to the iliotibial band is more easily distinguished from hip joint disorders because of its lateral location.6-8 These patients frequently present with a sensation that their hip is subluxing and can dynamically produce a maneuver that grossly suggests hip joint instability. However, this visual appearance is uniformly created by the tensor fascia lata flipping back and forth across the greater trochanter. If necessary, stability of the hip can be substantiated by obtaining plain films with the hip in the position that grossly looks subluxed, confirming a concentric reduction.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.