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Hamstring Injuries

Topic updated on 05/10/16 10:45am
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
    • semitendinosus topic
    • biceps femoris
      • long head topic
      • short head topic
  • 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%
Imaging
  • Radiographs
    • may show avulsion off ischial tuberosity  
  • MRI
    • may show avulsion off ischial tuberosity 
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 
        • partial avulsion that has failed nonoperative management for 6mths (persistent symptoms) 
      • 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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Qbank (5 Questions)

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

1. To act as an intermediary in the cell-signalling pathway for bone remodeling
2. To regenerate skeletal muscle after muscle injury
3. To regenerate periosteum after periosteal damage in a child
4. To bind chemotherapeutic ligands in the treatment of lymphoma of bone
5. To express high amounts of sonic hedgehog surface protein

PREFERRED RESPONSE ▶
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? Topic Review Topic
FIGURES: A          

1. Hamstring myotendinous junction rupture
2. Pelvic ramus fracture
3. Hamstring muscle belly rupture
4. Hamstring tendinous insertion rupture
5. Sports hernia

PREFERRED RESPONSE ▶
TAG
(OBQ07.217) Concomitant flexion of the hip and extension of the knee is most likely to result in an injury to which structure? Topic Review Topic

1. Sartorius
2. Rectus femoris
3. Adductor magnus
4. Biceps Femoris
5. Tensor fascia lata

PREFERRED RESPONSE ▶
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Cases

http://upload.orthobullets.com/cases/1784/hamstring t2 cor.jpg http://upload.orthobullets.com/cases/1784/hamstring t2 sag.jpg
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http://upload.orthobullets.com/cases/1533/case icon white back.jpg
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