Evaluation and Management of Hamstring Injuries

Abstract

Muscle injuries are the most common injuries in sports, with hamstring injuries accounting for 29% of all injuries in athletes. These injuries lead to prolonged impairment and have a reinjury risk of 12% to 31%. They range from mild muscle damage without loss of structural integrity to complete muscle tearing with fiber disruption. Novel MRI scores are increasingly being used and allow a more precise prediction of return to sport. In this article, the authors review the history, mechanisms of injury, and classification systems for hamstring injuries as well as present the latest evidence related to the management of hamstring injuries, including intramuscular and both proximal and distal insertional injuries. Indications for surgical treatment of certain proximal and distal avulsions, biological augmentation to the nonoperative treatment of midsubstance injuries, and advances in risk reduction and injury prevention are discussed.

Repair of Proximal Hamstring Tears: A Surgical Technique

“…In addition, some provocation tests can be performed to evaluate the severity of the injury, including the Puranen-Orava test, bent knee stretch test, and modified bent knee stretch test. 1 A plain radiograph may suffice and adequately demonstrate an avulsion fracture from the ischial tuberosity. Magnetic resonance imaging is recommended to visualize the proximal injury location, number of involved tendons, extent of injury, degree of retraction, and concomitant soft tissue lesions in the zone of injury.…”

“…1,2 The hamstring muscle group consists of 3 posterior thigh muscles, including the semimembranosus, semitendinosus, and the biceps femoris muscles. The tendon of the long head of the biceps femoris inserts laterally into the ischial tuberosity, while the tendon of the semitendinosus inserts medially.…”

Partial semitendinosus tendon tear in a young athlete: a case report and review of the distal semitendinosus anatomy

“…Non-operative management is utilized for hamstring musclebelly injuries and proximal origin injuries that involve a single tendon or multiple-tendon injuries with less than 2 cm of retraction [1]. Non-operative management would consist of non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and restricted activities while undergoing rehabilitation.…”

“…Hamstring injuries are common, accounting for 29 % of all sports-related muscle injuries [1]. The majority of these injuries are (myotendinous) strains followed by tears or avulsions of the proximal origin [2][3][4].…”

Investigation and management of an isolated complete distal avulsion of semitendinosus

“…The hamstring muscle group is one of the most commonly injured muscle groups in athletes, accounting for 29% of all sports-related muscle injuries 1. Most of the injuries sustained to the hamstrings are myotendinous strains and tears, with biceps femoris being the muscle most commonly implicated in injury 2 3…”