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Prolotherapy for Snapping Hip Syndrome

Feb
09
2012

Prolotherapy for Snapping Hip Syndrome

Snapping hip syndrome almost sounds too cute to be a problem, but for many it’s a big problem. Snapping is a form ofcrepitus, the medical term for any audible noise or internal sensation of popping, grinding, clicking or “snapping” in a joint. Crepitus is not a normal condition and signs of it point an injury or degenerative joint condition. Crepitus without pain is not necessarily a condition that needs to be treated and a large percentage of snapping hip cases do not have pain. Here at Caring Medical and Rehabilitation Services, Prolotherapist Ross Hauser, MD treats snapping hip when it causes pain and/or dysfunction in the joint. It is more likely to occur in younger (under 40) active athletes and dancers, but it is not unheard of in an older population.

Snapping Hip Syndrome: Is There a Cricket in My Hip or What?

This snapping sound comes from either inside the hip joint (intra-articular) or outside the joint (extra-articular). Broken cartilage fragments called loose bodies, labral tearsor fractures where the bone melds into cartilage are some causes of intra-articular snapping, but more common are the extra-articular reasons for this snapping sensation. The usual culprit is that the iliotibial band (IT band) snaps when it abnormally moves over the bony prominence on the outside of the hip, called the greater trochanter.Bursitis, a painful inflammation of the bursa sac can develop from the repetitive rubbing of the IT band tendon over the greater trochanter. Bursae are fluid-filled sacs that help cushion the structures of joints where there is a lot of movement. Another cause of snapping hip is when the large iliopsoas tendonabnormally moves over a different bony prominence of the pelvis, like the lesser trochanter or anterior iliac spine. The snapping and sometimes associated pain occurs with flexion or extension of the hip.

Do I Need Surgery for Snapping Hip?

Hackett-Hemwall dextrose Prolotherapy is a great treatment for snapping hip syndrome since it gets at the root cause of the problem, especially for the extra-articular etiologies. (Drs. Hackett and Hemwall were the first innovators of dextrose Prolotherapy since the 1940’s-50’s, using it in clinical and hospital settings for damaged connective tissues like tendons and ligaments.) The abnormal movement of these connective tissues rubbing over bony parts of the pelvis is due to these structures becoming lax or loose from repetitive use like in dance or sports or from a traumatic incident like a fall. The dextrose in the Prolotherapy solution, when injected around the injury, causes a mild inflammatory response, mimicking what the body does naturally in response to soft-tissue injuries. The immune system is drawn to the area of injury and immune cells and platelets release growth factors to build new healthy tissue.  The ligaments and tendons become thicker and stronger from this inflammatory reponse, proven decades ago in rabbit studies. When they do, the laxity or looseness of these structures is resolved and the snapping and pain goes away.

The intra-articular causes of snapping hip are usually more serious. But a Prolotherapy doctor, a specialist in this regenerative injection therapy like Dr. Hauser, can determine if Prolotherapy or surgery is called for. Loose bodies, usually bone or cartilage fragments, sometimes do have to be surgically removed if they are rubbing on other structures causing pain. If one has a tear of the labrum, a specialized structure/tissue that covers the joint capsules of hips and shoulders, it can cause pain and snapping. Then the doctor may have to use slightly more advanced techniques to resolve the problem. Platelet-rich plasma (PRP) is a type of Prolotherapy that uses a patient’s own blood, from which the platelets and their large concentrations of growth factors are used as part of the Prolotherapy solution. Labral tears usually respond well to PRP.

Degenerative Joint Disease and Snapping Hip Syndrome

Degenerative joint disease, or osteoarthritis, (OA) is the long-term result/worst-case scenario of what initially begins as a minor injury like snapping hip syndrome. If your IT band or iliopsoas tendon becomes chronically lax, meaning your snapping hip does not stop snapping in six months or so, it can lead to OA. OA is nothing more than cartilage loss with associated boney overgrowth. We all lose cartilage, the cushion between the bones of the joint so they can feely glide over one another, at varying rates. If we eat and exercise properly and keep our weight down, cartilage is made to last a lifetime. But when there are lax tendons and ligaments allowing abnormal motion, the cartilage wears out much more quickly. If these extra-articular problems are addressed in a timely manner, then the arthritic intra-articular problem is arrested. When caught early, normal dextrose Prolotherapy can help repair this cartilage damage. More severe cases, where x-rays and MRI’s show bone-on-bone, or basically no cartilage, then more sophisticated Prolotherapy may be needed. Here at Caring Medical we are doing what is called stem cell injection therapy for these severe cases. Bone marrow contains stems cells and growth factors. These stem cells can and do differentiate into the types of tissue that need to be regenerated, like cartilage. Much more info can be found on our website at caringmedical.com regarding BMP and all the other treatment modalities we have available for painful joint conditions. Dr. Hauser is considered the leading expert in the field of Prolotherapy and we literally have patients from all over the world come to Oak Park, IL to take advantage of his 18+ years of experience in regenerative injection medicine. If you have any questions, or would like to make an appointment, please give us a call.

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