A Pain in the Backside: A Case Report of Coxa Saltans Occurring at the Proximal Hamstring Origin

Abstract

Coxa saltans occurring at the proximal hamstring origin has been rarely reported in the literature. It is better known as occurring at the iliotibial band or the iliopsoas tendon. We report a case of coxa saltans due to subluxation of the origin of the long head of biceps femoris tendon at the ischial tuberosity. This was successfully treated using a mini-open surgical technique. Six weeks postoperatively, the snapping and the associated pain were abolished and the patient was able to resume their participation in athletic activities.

Atypical Coxa Saltans Due to Partial Proximal Hamstring Avulsion: A Case Presentation Highlighting the Role for Dynamic Sonography

“…In this setting, the proximal hamstrings, although detached from the insertion on the ischial tuberosity, remain in close proximity to the tuberosity and can subluxate, resulting in coxa saltans. Painful snapping of the hamstring, or “snapping bottom syndrome,” has been reported previously [5‐7]. In each case, partial rupture of the proximal hamstrings tendons caused painful snapping resulting from medial to lateral and lateral to medial subluxation of the tendons over the ischial tuberosity.…”

Surgical treatment of snapping proximal hamstring tendon syndrome: the resolution of snapping and excellent patient satisfaction

“…Aside from Spencer-Gardner et al. who performed a case of repair and reconstruction for this condition in 2015 [ 5 ], the few other documented cases to date have been treated with simple tenotomy [ 3 , 4 ]. Clinically, we find that patients may have had a chronic history of proximal hamstring tendinosis that progresses to full-thickness tearing, leaving the attachment to the STL intact, and thereby creating the snapping.…”

“…Previous case reports have primarily only documented the resolution of pain and snapping symptoms without further classification of outcome scores [ 2 , 3 ]. In the case report by Shur et al ., simple tenotomy resulted in the affected limb demonstrating a power of 4+ on the Medical Research Council scale, corresponding to reduced muscle strength compared with normal [ 4 ]. If one compares the PROs of this study with those of endoscopic and open proximal hamstring tendon repairs for non-snapping chronic partial and complete hamstring avulsions, they are similar.…”

“…In the first reported case of ‘snapping bottom’ by Rask, the resolution of symptoms was achieved by simple tenotomy [ 2 ]. Subsequent cases also found success in the use of tenotomy for the resolution of pain and snapping [ 3 , 4 ]. In 2015, Spencer-Gardner et al .…”