Updated: 10/1/2018

Hamstring Injuries

Topic
Review Topic
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Questions
5
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Evidence
10
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Videos
5
Cases
2
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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 skiers
  • Mechanism
    • occurs as a result of hip flexion and knee extension 
  • Pathophysiology
    • satellite cell plays a role in muscle healing following muscle injury 
Relevant Anatomy
  • "Hamstring" muscles include  
    • semimembranosus topic
      • most lateral attachment
    • semitendinosus topic
      • semitendinosus and biceps femoris (long head) attach medial to semimembranosus
    • biceps femoris
      • long head topic
        • attaches medial to semimembranosus
      • short head topic
        • originates from linea aspera
  • 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)
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%
    • stiff legged gait (avoiding knee and hip flexion)
Imaging
  • Radiographs
    • may show avulsion off ischial tuberosity  
  • MRI
    • may show avulsion off ischial tuberosity 
Treatment
  • Nonoperative
    • rest, ice, NSAIDS, protected weightbearing for 4 weeks followed by stretching and strengthening
      • indications
        • most hamstring injuries
        • single tendon, retraction ≤1-2cm
        • 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 
        • partial avulsion that has failed nonoperative management for 6mths (persistent symptoms) 
        • at least 2 tendons but > 2cm retraction in young, active patients
      • 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  
      • results
        • easier to mobilize acute ruptures than chronic ruptures
        • repair of acute ruptures has less sciatic nerve scarring
          • chronic ruptures may require sciatic neurolysis
Complications
  • Weakness in knee flexion, hip extension
  • Hamstring syndrome
    • posterior buttock and ischial tuberosity pain
    • treatment
      • surgical release and sciatic nerve decompression
  • Sciatic nerve scarring and sciatic neuralgia
 

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Questions (5)
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(OBQ12.152) Which of the following most accurately describes the primary role of satellite cells? Review Topic

QID: 4512
1

To act as an intermediary in the cell-signalling pathway for bone remodeling

24%

(1077/4474)

2

To regenerate skeletal muscle after muscle injury

66%

(2940/4474)

3

To regenerate periosteum after periosteal damage in a child

3%

(149/4474)

4

To bind chemotherapeutic ligands in the treatment of lymphoma of bone

2%

(95/4474)

5

To express high amounts of sonic hedgehog surface protein

4%

(168/4474)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(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

QID: 878
1

Sartorius

6%

(170/2630)

2

Rectus femoris

11%

(281/2630)

3

Adductor magnus

0%

(11/2630)

4

Biceps Femoris

81%

(2130/2630)

5

Tensor fascia lata

1%

(34/2630)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(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

QID: 836
FIGURES:
1

Hamstring myotendinous junction rupture

68%

(840/1241)

2

Pelvic ramus fracture

2%

(21/1241)

3

Hamstring muscle belly rupture

4%

(44/1241)

4

Hamstring tendinous insertion rupture

26%

(320/1241)

5

Sports hernia

1%

(15/1241)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
ARTICLES (19)
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CASES (2)
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