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Proximal Hamstring Injury
Kirkland W. Davis, MD, FACR; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Acute: Pulled hamstring, hamstring strain
              • Chronic: Tendinopathy, tendonitis, hamstring syndrome
            • Definitions

              • Hamstrings: Biceps femoris (BF), semimembranosus (SM), and semitendinosus (ST); adductor magnus occasionally included in list
              • Acute myotenoosseous injury of hamstring tendon(s) &/or muscle(s) with microscopic or macroscopic fiber disruption
              • Chronic degenerative tendinopathy or enthesopathy involving hamstring origins

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Bierry G et al: Sacrotuberous ligament: relationship to normal, torn, and retracted hamstring tendons on MR images. Radiology. 271(1):162-71, 2014
                                              2. Fader RR et al: Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J. 4(4):461-6, 2014
                                              3. Hamilton B et al: Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries. Br J Sports Med. 48(18):1385-7, 2014
                                              4. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                              5. Moen MH et al: Predicting return to play after hamstring injuries. Br J Sports Med. 48(18):1358-63, 2014
                                              6. Sanfilippo JL et al: Hamstring strength and morphology progression after return to sport from injury. Med Sci Sports Exerc. 45(3):448-54, 2013
                                              7. Silder A et al: Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 43(5):284-99, 2013
                                              8. De Smet AA et al: MRI appearance of the proximal hamstring tendons in patients with and without symptomatic proximal hamstring tendinopathy. AJR Am J Roentgenol. 198(2):418-22, 2012
                                              9. Linklater JM et al: Hamstring injuries: anatomy, imaging, and intervention. Semin Musculoskelet Radiol. 14(2):131-61, 2010
                                              10. Carmichael J et al: Avulsion of the proximal hamstring origin. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:249-56, 2009
                                              11. Housner JA et al: Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 28(9):1187-92, 2009
                                              12. Lempainen L et al: Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 37(4):727-34, 2009
                                              13. Askling CM et al: Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 36(9):1799-804, 2008
                                              14. Davis KW: Imaging of the hamstrings. Semin Musculoskelet Radiol. 12(1):28-41, 2008
                                              15. Silder A et al: MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol. 37(12):1101-9, 2008
                                              16. Wood DG et al: Avulsion of the proximal hamstring origin. J Bone Joint Surg Am. 90(11):2365-74, 2008
                                              17. Koulouris G et al: Imaging of hamstring injuries: therapeutic implications. Eur Radiol. 16(7):1478-87, 2006
                                              18. Bencardino JT et al: Hamstring injuries of the hip. Magn Reson Imaging Clin N Am. 13(4):677-90, vi, 2005
                                              19. Koulouris G et al: Hamstring muscle complex: an imaging review. Radiographics. 2005 May-Jun;25(3):571-86. Review. Erratum in: Radiographics. 25(5):1436, 2005
                                              20. Clanton TO et al: Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. 6(4):237-48, 1998
                                              21. Cross MJ et al: Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med. 26(6):785-8, 1998
                                              22. El-Khoury GY et al: Imaging of muscle injuries. Skeletal Radiol. 25(1):3-11, 1996
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Acute: Pulled hamstring, hamstring strain
                                                          • Chronic: Tendinopathy, tendonitis, hamstring syndrome
                                                        • Definitions

                                                          • Hamstrings: Biceps femoris (BF), semimembranosus (SM), and semitendinosus (ST); adductor magnus occasionally included in list
                                                          • Acute myotenoosseous injury of hamstring tendon(s) &/or muscle(s) with microscopic or macroscopic fiber disruption
                                                          • Chronic degenerative tendinopathy or enthesopathy involving hamstring origins

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Bierry G et al: Sacrotuberous ligament: relationship to normal, torn, and retracted hamstring tendons on MR images. Radiology. 271(1):162-71, 2014
                                                                                          2. Fader RR et al: Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J. 4(4):461-6, 2014
                                                                                          3. Hamilton B et al: Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries. Br J Sports Med. 48(18):1385-7, 2014
                                                                                          4. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                                                                          5. Moen MH et al: Predicting return to play after hamstring injuries. Br J Sports Med. 48(18):1358-63, 2014
                                                                                          6. Sanfilippo JL et al: Hamstring strength and morphology progression after return to sport from injury. Med Sci Sports Exerc. 45(3):448-54, 2013
                                                                                          7. Silder A et al: Clinical and morphological changes following 2 rehabilitation programs for acute hamstring strain injuries: a randomized clinical trial. J Orthop Sports Phys Ther. 43(5):284-99, 2013
                                                                                          8. De Smet AA et al: MRI appearance of the proximal hamstring tendons in patients with and without symptomatic proximal hamstring tendinopathy. AJR Am J Roentgenol. 198(2):418-22, 2012
                                                                                          9. Linklater JM et al: Hamstring injuries: anatomy, imaging, and intervention. Semin Musculoskelet Radiol. 14(2):131-61, 2010
                                                                                          10. Carmichael J et al: Avulsion of the proximal hamstring origin. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:249-56, 2009
                                                                                          11. Housner JA et al: Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 28(9):1187-92, 2009
                                                                                          12. Lempainen L et al: Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 37(4):727-34, 2009
                                                                                          13. Askling CM et al: Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. 36(9):1799-804, 2008
                                                                                          14. Davis KW: Imaging of the hamstrings. Semin Musculoskelet Radiol. 12(1):28-41, 2008
                                                                                          15. Silder A et al: MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol. 37(12):1101-9, 2008
                                                                                          16. Wood DG et al: Avulsion of the proximal hamstring origin. J Bone Joint Surg Am. 90(11):2365-74, 2008
                                                                                          17. Koulouris G et al: Imaging of hamstring injuries: therapeutic implications. Eur Radiol. 16(7):1478-87, 2006
                                                                                          18. Bencardino JT et al: Hamstring injuries of the hip. Magn Reson Imaging Clin N Am. 13(4):677-90, vi, 2005
                                                                                          19. Koulouris G et al: Hamstring muscle complex: an imaging review. Radiographics. 2005 May-Jun;25(3):571-86. Review. Erratum in: Radiographics. 25(5):1436, 2005
                                                                                          20. Clanton TO et al: Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. 6(4):237-48, 1998
                                                                                          21. Cross MJ et al: Surgical repair of chronic complete hamstring tendon rupture in the adult patient. Am J Sports Med. 26(6):785-8, 1998
                                                                                          22. El-Khoury GY et al: Imaging of muscle injuries. Skeletal Radiol. 25(1):3-11, 1996