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Introduction
Hamstring injuries are common in athletes but can also occur during falls or accidents in any individual. Injuries can range from a small inconvenient strain to a complete avulsion of the entire hamstring group. Often times these subtle injuries can be managed without surgery, with patients expecting a full recovery to normal activities. However, the more significant injuries can require surgery to alleviate pain and dysfunction.
Anatomy
(https://teachmeanatomy.info/lower-limb/muscles/thigh/hamstrings/)
The proximal hamstring complex is composed of three main muscles. The semimembranosus which has a broad attachment to the lateral side of the ischium, the biceps femoris and semitendinosus which have a shared attachment, termed the conjoint tendon, at the iscial tuberosity. These muscles cross the knee joint and have the primary function of flexing the knee.
Miller T.L. (2014) Acute Proximal Hamstring Tendon Avulsions. In: Kaeding C., Borchers J. (eds) Hamstring and Quadriceps Injuries in Athletes. Springer, Boston, MA (https://media.springernature.com/lw785/springer-static/image/chp%3A10.1007%2F978-1-4899-7510-2_5/MediaObjects/314062_1_En_5_Fig12_HTML.jpg)
Symptoms
Athletes will commonly describe a tearing sensation and sometime hear or feel a pop in their buttock and/or posterior thigh region. This is often times followed by a large amount of brusing and swelling in the back of the thigh and knee over the next few days. Patients can have numbness or pins and needle senation over their thigh and leg due to irritation of the sciatic nerve. And with muscle injuries there is commonly cramping and weakness.
Diagnosis
Once a hamstring tear or injury is suspected xrays a generally taken to rule out an avulsion fracture of the ischium (where the muscle pulls a piece of bone off.) Once this is ruled out an MRI is generally the next step to assess the degree of injury.
Treatment
Initial treatment consist of rest, oral anti-inflammatories and physical therapy. Smaller acute symptomatic tears that improve over the first week or two after injury can continue with non-operative care. If symptoms do not improve or cramping and pain increase, or if the tear is larger then surgical management may be indicated. This can consist of either an open approach where an incision is made in the buttock crease and/or posterior thigh, additionally endoscopic techniques can be used on their own or combined with open techniques in order to provide a robust repair. A fair goal is returning to running at low speeds and duration by 3-4 months and return to sport in 6-9 months.
Our experienced hip specialists are well versed in both operative and non-operative care of the hip including open and endoscopic hamstring repair as well as in-office ultrasound-guided hip injections.
Don’t wait until the pain is unbearable or severely limits your activity. Give us a call at 816-841-3805 to schedule an evaluation, or contact us online today.
More information can be found at AAOS
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