Hamstring Injuries: Anatomy, Imaging, and Intervention

Abstract

Injury to the hamstring muscle complex (HMC) is extremely common in the athletic community. Anatomical and functional aspects of the HMC predispose it to injury, including the fact that the muscles cross two joints and undergo eccentric contraction during the gait cycle. Injury most commonly occurs at the muscle tendon junction but may occur anywhere between the origin and insertion. Complete hamstring avulsions require early surgical repair. The principal indication for imaging is in a triage role to rule out or confirm proximal hamstring avulsion. Acute onset and chronic posterior thigh and buttock pain may relate to pathology at the hamstring origin or muscle tendon junction that can be readily defined on magnetic resonance imaging or, less frequently, ultrasound. Some cases of buttock and thigh pain may relate to spinal pathology. In the elite athlete there is an increasing emphasis on optimizing the rehabilitation process after hamstring injury, to minimize the absence from sports and improve the final outcome. Imaging has a role in confirming the site of injury and characterizing its extent, providing some prognostic information and helping plan treatment. There is increasing interest in the use of growth factors to accelerate healing after muscle and tendon injury. Animal studies have demonstrated clear benefits in terms of accelerated healing. There are various methods of delivery of the growth factors, all involving the release of growth factors from platelets. These include plasma rich in platelets and autologous blood. Clinical studies in humans are very limited at this stage but are promising. At present the World Anti-Doping Authority bans the intramuscular administration of these agents. Other percutaneous injection therapies include the use of Actovegin and Traumeel S and antifibrotic agents.

Evaluation and Imaging of an Untreated Grade III Hamstring Tear: A Case Report

“…Nonsurgical management is the standard of care for myotendinous injuries [29], although the required rehabilitation can be protracted from 6 to 50 months [16]. Tests that measure strength, ROM, and pain can provide a reasonable estimate of rehabilitation duration in injuries involving the intramuscular tendon and adjacent muscle fibers [39,43].…”

“…Surgeons are more likely to recommend repair of proximal hamstring-origin complete avulsions because of the risk for tendon retraction and progressive functional impairment with time [29], whereas the majority of hamstring muscle injuries respond well to nonoperative treatment [5,36]. In a review of hamstring injuries, Linklater et al [29] note that ''proximal hamstring avulsions are of particular importance because of the substantially improved outcome with early surgical repair''. They also note that, without proper imaging, it can be difficult clinically to distinguish origin avulsions from muscletendon junction injury.…”

Radiological interventions for soft tissue injuries in sport

“…The pharmacology is not understood but it is thought to suppress inflammatory mediators and stimulate the release of anti-inflammatory cytokines [24]. It is used both topically and by local injection.…”

An Anomalous Muscular Bundle Connecting Biceps Femoris to Semitendinosus

“…With the exception of the BFSH, hamstrings are innervated by the tibial part of sciatic nerve. The sciatic nerve passes the proximal hamstring muscle complex on the lateral side at a distance of approximately 1 cm from most lateral aspect [3].…”

“…These muscles are long, biarticular, and involved in many types of locomotion. Anatomical and functional features of Hamstring muscle complex predispose it to injury [3]. Therefore it is not suprising that injuries of the hamstring muscle complex are more common in many sports and have increased in recent times [4].…”