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

Abstract

Painful hip snapping can present as a rare sequela of proximal hamstring injury. We present a case of painful snapping of the conjoint tendon of the semitendinosus and biceps femoris over the ischial tuberosity in the setting of a partial proximal hamstring disruption. Dynamic ultrasonography identified the source of snapping and a persistent attachment of the conjoint tendon to the sacrotuberous ligament, which prevented retraction and allowed subluxation of the tendons across the ischial tuberosity. Following surgical transection of the persistent sacrotuberous ligament attachment to the conjoint tendon and tendon reattachment, the patient's symptoms resolved with full return of function.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for (Adult) Hip

“…For instance, partial avulsion of the proximal hamstrings might cause snapping because of medial or lateral dislocation of the conjoint tendon over the ischial tuberosity (Video 23, http://links.lww.com/PHM/B728). Notably, the dislocated tendon can also displace the sciatic nerve 44–46 …”

Ultrasound Features of the Proximal Hamstring Muscle‐Tendon‐Bone Unit

“…Painful snapping of the hip, also called coxa saltans, might be subsequent to proximal hamstring muscle complex injury and tendinopathy, caused by subluxation of the conjoint tendon over the ischial tuberosity. Dynamic US has been shown to be capable of depicting this kind of snapping during hip flexion …”

“…Dynamic US has been shown to be capable of depicting this kind of snapping during hip flexion. 23 The examiner should keep in mind that tendinopathy may affect only a tract, possibly the intramuscular distal part of the tendons, leading to nonspecific posterior thigh pain, and therefore should check the tendons in their whole course with axial US scans: only a systematic and comparative evaluation allows the diagnosis necessary for the athlete to plan rehabilitation and avoid injuries ( Figures 10 and 11).…”

Beckennahe Sehnenverletzungen

“…[3]. Selten kann das Phänomen der "schnappenden Hüfte" (Coxa saltans) mit hör-und fühl-barem, teils schmerzhaftem Schnappen beobachtet werden [4]. In der klinischen Untersuchung ist bei kompletter Ruptur und deutlicher Retraktion eine Muskellücke als Ausdruck des Sehnendefekts zu palpieren.…”