Diagnosis and prognosis of acute hamstring injuries in athletes

Abstract

PurposeIdentification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes.MethodsA literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes.ResultsMedical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism.ConclusionsPosture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors.Level of evidenceLiterature review and expert opinion, Level V.

MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance

“…Reinjury is unfortunately common, occurring in up to 15% of strains, and generally requires a longer convalescence than after the initial trauma (69,70) (Fig 33). Functional recovery precedes full structural recovery, so residual imaging alterations may be present even after the athlete feels healed; whether such residua indicate a higher risk of reinjury is unclear (1).…”

Return to sport after muscle injury

“…The purpose of physical examination is to determine the location and severity of the injury, more so than the presence. An assessment shortly after injury is recommended as this allows for quicker intervention and a more reliable medical history [24]. Physical examination may reveal swelling and ecchymosis.…”

“…Palpation serves to detect a discrete defect, edema, and increased muscle tone due to injury [25]. Strength testing is best done with bilateral comparison to identify decreased strength of the injured muscle or post-injury changes [24]. Although many patients will not have significant strength deficits with manual testing, side to side pain or difficulty with expending full effort should suggest that a patient has a muscle injury.…”

“…Although many patients will not have significant strength deficits with manual testing, side to side pain or difficulty with expending full effort should suggest that a patient has a muscle injury. Active range of motion tests should be conducted 48 h after injury as significant pain and disability is present immediately following injury and would provide for an unreliable ROM assessment [24,26]. Imaging can help confirm injury.…”

Hamstring Muscle Injury

“…The initial assessment should take place within 2 days post-injury to ensure a reliable medical history and possibility of a quick intervention when necessary, yet allow possible signs of swelling and hematoma to develop [ 14 ]. Inspection should mainly focus on posture and gait examination, focal swelling, and hematoma.…”