III Division of Orthopaedics and Trauma, Gaetano Pini Orthopaedic Institute, Piazza C. Ferrari, 1, Milan, Italy.
Clin Orthop Relat Res. 2010 Oct;468(10):2814-8. doi: 10.1007/s11999-009-1208-9. Epub 2010 Jan 7.
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.
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.
弹响髋是由髂腰肌肌腱反复脱位引起的综合征。对于导致肌腱急动的撞击部位，目前尚未达成共识。到目前为止，小转子、前囊和髂耻隆起被认为是最有可能的卡压部位。
我们报告了一个不常见的病例，股直肌直接头的钙化性肌腱炎直接撞击覆盖的髂肌，导致疼痛性弹响髋。标准 X 线片仅显示直接头的参与，隐藏了钙沉积，而 MRI 虽然提示但未能很好地显示肌腱疾病。动态超声和 CT 扫描可进行精确诊断，并随后进行 CT 引导下类固醇注射治疗。
股直肌直接头的钙化性肌腱炎尚未被报道为弹响髋的可能原因；在一例病例中描述了股直肌钙化性肌腱炎中直接头的参与。
我们的病例表明股直肌直接头可能参与了弹响髋的病因。理论上，任何肌腱增厚都可能激活相同的病理机制。当排除了最常见的原因后，医生应考虑这种可能的新的弹响髋内部原因，特别是因为它可以通过类固醇注射轻松治疗。
