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There are multiple hypothesized etiologies for internal snapping hip. One example is the iliopsoas tendon snapping between its muscle and the superior pubic rami. With flexion–abduction–external rotation of hip, iliopsoas tendon (hyperechoic, white round structure) rolls laterally and anteriorly over its muscle, trapping it between the tendon and superior pubic ramus (white horizontal line at bottom). As hip is progressively brought back to neutral position, iliopsoas tendon and trapped component of muscle follow progressively reverse path (medially and posteriorly for tendon and laterally for muscle) until the muscle is suddenly released laterally, allowing abrupt return of iliopsoas tendon against superior pubic ramus, producing an audible snap.
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