| Introduction |
 Hamstring injuries can occur at any level in hamstring
- myotendinous junction
- is the most common site of rupture
- often occurs during sprinting
- avulsion of ischial tuberosity
- less common
- seen in skeletally immature
- seen in water skiiers
- Mechanism
- occurs as a result of hip flexion and knee extension
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| Relevant Anatomy |
- "Hamstring" muscles include
- semimembranous
- semitendinosus
- biceps femoris
- long head
- short head
- Common characteristics of hamstring muscles include
- originate on ischial tuberosity
- innervated by sciatic (tibial) nerve
- blood supply from inferior gluteal artery and profunda femoral artery
- cross and act upon 2 joints: the hip and knee (except short head of biceps femoris)
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| Presentation |
- Physical exam
- ecchymosis in posterior thigh
- may have palpable mass in middle 1/3 of posterior thigh (myotendinous rupture)
- normal hamstring/quadricep ratio is 65%
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| Imaging |
- Radiographs
- may shows avulsion off ischial tuberosity
- MRI
- may shows avulsion off ischial tuberosity
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| Treatment |
- Nonoperative
- protected weightbearing for 4 weeks followed by stretching and strengthening
- indications
- most hamstring injuries
- rupture at myotendinous junction
- return to play
- only when strength is 90% of contralateral side to avoid further injury
- Operative
- operative repair
- indications
- proximal avulsion ruptures
- surgical technique
- transverse incision at gluteal crease
- protection of the sciatic nerve
- mobilization of the ruptured tendons
- repair to the ischial tuberosity with the use of suture anchors
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Please Rate Educational Value!
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4.0
t-3102
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Average 4.0 of 11 Ratings
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Qbank (2 Questions)
TAG
(OBQ07.175)
A 15-year-old boy sustains the injury seen in Figure A while running the hurdles. The same mechanism in an adult athlete would most likely result in which of the following injuries?
Review Topic
DISCUSSION:
This adolescent has sustained injury an avulsion injury of the ischial tuberosity. This is also referred to as a “hurdlers fracture” which occurs during excessive hamstring tension. This injury in a skeletally mature adult would most likely be a hamstring rupture. Hamstring ruptures in adults most often occur at the myotendinous junction but can occur at other areas including the muscle belly and tendinous insertion. Nonoperative management, starting with protected weightbearing for 4 weeks followed by physical therapy. Surgical management may be considered if the fragment is large enough to accommodate hardware and if displacement is greater than 2 cm.
The review articles by Scopp and Anderson discuss a variety of injuries to the hip and groin that occur in athletes.
REFERENCES:
1.
Scopp JM, Moorman CT 3rd. Acute athletic trauma to the hip and pelvis. Orthop Clin North Am. 2002 Jul;33(3):555-63.
PMID:12483951 (Link to Abstract)
2.
Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001 Jul-Aug;29(4):521-33.
PMID:11476397 (Link to Abstract)
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Please Rate Educational Value!
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2.0
q-836
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Average 2.0 of 16 Ratings
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TAG
(OBQ07.217)
Concomitant flexion of the hip and extension of the knee is most likely to result in an injury to which structure?
Review Topic
DISCUSSION:
Flexion of the hip and extension of the knee most likely would injure the hamstring. The hamstring is composed of the semimembranosus, semitendinosus, and biceps femoris and all three components originate at the ischial tuberosity. The article by Orava reviewed 8 patients with proximal hamstring rupture and reported that there is an eccentric component to the injury with forceful contraction of the hamstring with simultaneous lengthening of the muscle with hip flexion and knee extension. The level 4 study by Klingele reviewed 11 patients treated operatively for proximal hamstring rupture and found 91% return of muscle strength postoperatively.
REFERENCES:
1.
Orava S, Kujala UM. Rupture of the ischial origin of the hamstring muscles. Am J Sports Med. 1995 Nov-Dec;23(6):702-5
PMID:8600738 (Link to Abstract)
2.
Klingele KE, Sallay PI. Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med. 2002 Sep-Oct;30(5):742-7
PMID:12239012 (Link to Abstract)
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Please Rate Educational Value!
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3.0
q-878
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Average 3.0 of 10 Ratings
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Cases
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HPI -
62yo female, no sports, retired. After fall in hiperflexión of hip with extended...
What treatment would you choose?
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1 week ago
282
responses
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HPI -
Is a female with 2 months of pain in the distal third of the thigh on its inner...
Diferencial diagnoses
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12/5/2012
30
responses
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See More Cases
Groups
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
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Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001 Jul-Aug;29(4):521-33.
PMID:11476397 (Link to Abstract)
-
Scopp JM, Moorman CT 3rd. Acute athletic trauma to the hip and pelvis. Orthop Clin North Am. 2002 Jul;33(3):555-63.
PMID:12483951 (Link to Abstract)
Textbooks
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
- Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
- Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
- Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Undefined
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Klingele KE, Sallay PI. Surgical repair of complete proximal hamstring tendon rupture. Am J Sports Med. 2002 Sep-Oct;30(5):742-7
PMID:12239012 (Link to Abstract)
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Orava S, Kujala UM. Rupture of the ischial origin of the hamstring muscles. Am J Sports Med. 1995 Nov-Dec;23(6):702-5
PMID:8600738 (Link to Abstract)
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