Whenever I extend my leg and then bend it again, I get a painful snapping across the front of my hip. It’s loud enough you can actually hear it. The orthopedic surgeon says it’s a snapping hip syndrome. Nothing showed up on an X-ray. Would it be helpful to have a CT scan or an MRI to make sure that’s really what’s wrong?

The diagnosis of snapping hip syndrome usually only requires a careful patient history and examination. Many times, the patient and/or examiner are able to reproduce the symptoms. This helps identify the soft tissue structures that are involved.

The cost of more advanced imaging is always taken into consideration. Since the first step in treatment is the same regardless of the exact diagnosis, your surgeon may hold off on further imaging studies for a while.

Conservative care with rest, stretching exercises, and avoiding repetitive motions that aggravate the condition is advised. A physical therapist may also use deep heating treatments such as ultrasound or iontophoresis (antiinflammatory medications pushed through the skin to the tendon).

Magnetic resonance imaging or ultrasound for imaging (rather than for providing heat treatment) becomes helpful if and when the surgeon is considering a steroid injection into the iliopsoas bursa. The bursa is a small, oval-shaped soft tissue structure between the bone and the tendon. It helps reduce friction and provides smooth action of the tendon-muscle unit.

In the case of snapping hip syndrome, magnetic resonance arthrography (MRA) may be a better choice. A contrast dye is injected into the joint to help look for problems within (inside) the joint. This could be a loose fragment of cartilage or bone — or a frayed or torn piece of the labrum (rim of cartilage around the hip socket).

Dynamic ultrasound is another good diagnostic option. Images of the iliopsoas tendon show signs of tendon thickening, enlarged burse, pockets of fluid collection, or signs of inflammation. Each of these tests has its own sensitivity and specificity making them useful for certain patients. The surgeon is able to identify which test is best and when to use it to avoid unnecessary test procedures but gain important and necessary information when it’s needed.