Fibrosis of the gluteus maximus as a cause of snapping hip. A case report.

External Snapping Hip Syndrome: Emphasis on the MR Imaging

“…In our study, there were no cases that developed due to repeated intramuscular injection of antibiotics or analgesics. The major causes of external snapping hip syndrome are currently thought to be the gluteus maximus and the iliotibial band in most cases (6)(7)(8)(9). Similarly in our study, the cases showing the thickening of the anterior border of the gluteus maximus and the iliotibial band simultaneously was 55%, and the percent of cases with thickening of the gluteus maximus or the iliotibial band only was 86 %, and 55 %, respectively.…”

“…In addition to the fascia lata being the cause, there has been a reported case that developed snapping hip syndrome due to a band of fibrous tissue that corresponded to a portion of the gluteus maximus muscle. Such fibrosis may be developed due to repeated intramuscular injection of antibiotics and analgesics or during the treatment process of chronic illness, yet blood vessel injury may develop even after one injection (9). In our study, there were no cases that developed due to repeated intramuscular injection of antibiotics or analgesics.…”

“…The internal type of extraarticular snapping is the iliopsoas tendon slipping over the iliopectineal eminence. Other causes include iliopsoas bursa slipping of the iliofemoral ligament over the femoral head and slipping of the long head of the biceps femoris tendon over the ischial tuberosity (1,(6)(7)(8)(9)(10) Mayer insisted that the major factors of snapping hip syndrome were abnormality of the fascia lata that forms the catch back of the posterior greater trochanter, unusual prominency of the trochanter, abnormal relaxation of the gluteus maximus muscle and irregularities of the acetabulum (8). In addition to the fascia lata being the cause, there has been a reported case that developed snapping hip syndrome due to a band of fibrous tissue that corresponded to a portion of the gluteus maximus muscle.…”

Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome

“…Possible structures involved include the proximal hamstring tendon snapping over the ischial tuberosity or, more commonly, snapping of the iliotibial band (ITB), fascia lata, gluteus maximus (GM), or a combination of these over the greater trochanter (GT). Trochanter deformities, big offsets, or bone spurs may also have a role [1,7,11,12]. The latter situation refers to a conflict in the relationship between the posterior ITB or the anterior aspect of the GM muscle as it travels over the GT [10,12].…”

“…Subluxation of the ITB over the GT may occur with hip extension, and in this situation, the ITB moves from an anterior to a posterior position relative to the GT. In addition to this, during hip extension, the distal border of the GM tendon (GMT) may snap over the GT [1,8].…”