Coxa saltans

Specialty: Musculoskeletal.

• spring hip
• symptomatic hip snapping
• bouncing hip

Why it occurs

• Displacement of the iliotibial band or gluteus maximus tendon on the greater trochanter (external spring, most common cause)
• Displacement of the iliopsoas muscle tendon on the iliopubic eminence or the femoral head (internal spring)
• Acetabular labral tears or intra-articular loose bodies (intra-articular spring)
• Hypertrophy of the trochanteric bursa or the iliopsoas bursa
• Congenital or acquired hip ligamentous laxity

Initial workup

Physical exploration (reproduction of the spring through active or passive flexion-extension and adduction movements) | Dynamic musculoskeletal ultrasound (allows real-time visualization of the passage of the tendon over the bony prominences) | Hip MRI if intra-articular cause is suspected.

Standard management

• Naproxen — 500 mg every 12 hours orally for 5-7 days if there is associated synovitis or painful bursitis
• Diclofenac diethylammonium gel 1.16% — apply to the trochanteric area every 8 hours
• Ultrasound-guided infiltration of methylprednisolone (40 mg into the iliopsoas bursa for internal spring, or trochanteric bursa for external spring).