Two unrelated young girls were evaluated for a gait suspected to be functional (video 1). Hip movements during ambulation were excessive despite normal tone, strength, sensation, and muscle stretch reflexes. Ascertainment of joint hypermobility led to the diagnosis of Ehlers-Danlos syndrome in both. Coxa saltans, also known as “dancer's hip” or “snapping hip,” may develop among young athletes with clicking joints due to connective tissue disorders.1 The gluteus maximum tendon, iliotibial band, or tensor fascia lata slide back and forth across the greater trochanter during flexion–extension movements in external coxa saltans (figure). Case 1 required bilateral iliotibial band lengthening surgery.2
Video 1
Video demonstrates the abnormal movements around the hip girdle during gait on a hallway and on the stairs for patient 1 (segment 1) and patient 2 (segment 2). Note that the hip movements become overt only during weight-bearing, which “strain” the affected joint, but are absent when recumbent.Download Supplementary Video 1 via http://dx.doi.org/10.1212/005955_Video_1
Sagittal (left) and coronal (right) view of the relationship between the gluteus maximum tendon, iliotibial band, and tensor fascia lata with the greater trochanter.
Author contributions
Drs. Gilbert and Wu: acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. Dr. Espay: report analysis and interpretation, critical revision of the manuscript for important intellectual content.
Study funding
No targeted funding reported.
Disclosure
D. Gilbert has received honoraria and/or travel support from the Tourette Association of America/Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the Child Neurology Society. He has received book royalties from Elsevier and Wolters Kluwer. He has received compensation for expert testimony for the US DOJ DVIC program. Dr. Gilbert has received research support from the NIH (NIMH, NINDS). He has received funding for work as a clinical trial site investigator from Ecopipam Pharmaceuticals (clinical trial, Tourette syndrome) and EryDel (clinical trial, ataxia-telangiectasia). A. Espay has received grant support from the NIH, Great Lakes Neurotechnologies, and the Michael J. Fox Foundation; personal compensation as a consultant/scientific advisory board member for AbbVie, TEVA, Impax, Acadia, Acorda, Cynapsus/Sunovion, Lundbeck, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from AbbVie, UCB, USWorldMeds, Lundbeck, Acadia, the American Academy of Neurology, and the Movement Disorders Society. He serves on the editorial boards of the Journal of Parkinson's Disease and Parkinsonism and Related Disorders. S. Wu has received grant support from NIH and Tourette Association of America and is the site principal investigator for EryDel SpA-sponsored clinical trial for ataxia-telangiectasia. Go to Neurology.org/N for full disclosures.
Acknowledgment
The authors thank Marcia Hartsock, MA, CMI, for the original illustration detailing the hip anatomy in the figure.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- © 2018 American Academy of Neurology
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