Hamstring Injuries, symptoms, diagnosis and treatment

The hamstrings are a group of muscles located at the back of the thigh.

The hamstring muscles include the semitendinosus, semimembranosus, and the biceps femoris (both long and short heads).

The proximal end of the hamstring muscles originates from the ischial tuberosity of the pelvis.
The hamstring muscles arise from the ischium of the pelvis, close to the sciatic nerve, and they are innervated by the sciatic nerve.
The hamstring muscles are the major flexors of the knee and assist in hip extension.
Injuries to the hamstring muscles often occur proximally and are a common cause of chronic pain and disability, especially in athletes.

Mechanism of injury:
A typical mechanism is the so-called hurdler’s injury. Athletes attempting to clear hurdles are prone to hamstring injury due to excessive tension placed on the muscles.

Classification of hamstring strain:
Minor tear within the muscle
Partial tear within the muscle
Complete tear of the muscle

Most hamstring injuries occur at the musculotendinous junction, though they can also occur at the insertion site on the ischial tuberosity.
Severe hamstring injuries may involve a tendon avulsion fracture, where the tendon tears away from the bone along with a bony fragment. This type of injury is typically seen in skeletally immature athletes.
Clinical examination:
Patients usually report sharp pain in the back of the thigh, often accompanied by a sensation of popping or tearing.
The physician may observe bruising (ecchymosis) on the posterior thigh and feel a palpable mass at the site of injury.
The diagnosis is usually confirmed by MRI.
Treatment:
For muscle strain or pulled hamstring, often due to insufficient warm-up, treatment includes rest, ice, compression bandage, elevation (RICE protocol), and physiotherapy.
For complete avulsion injuries with muscle retraction, early surgery is recommended. The procedure involves making an incision, identifying the retracted muscle and tendon, protecting the nerve, and reattaching the tendon to the ischial tuberosity using anchors.
In cases of bony avulsion, screws may be used to fix the bone fragment to the ischium.
An example is provided of a patient with a hamstring avulsion repaired using multiple anchors due to the patient's size.
Quizzes
1. Where are the hamstring muscles located?
a) Front of the thigh
b) Back of the thigh
c) Lateral leg
d) Anterior shin
Correct answer: b) Back of the thigh
Explanation: The hamstrings are located at the posterior thigh.

2. Which nerve innervates the hamstring muscles?
a) Femoral nerve
b) Sciatic nerve
c) Obturator nerve
d) Saphenous nerve
Correct answer: b) Sciatic nerve
Explanation: The hamstrings are supplied by the sciatic nerve.

3. What is a common mechanism for hamstring injury in athletes?
a) Twisting injury
b) Hurdler’s injury
c) Direct blow
d) Overuse from walking
Correct answer: b) Hurdler’s injury
Explanation: Hurdler’s injury occurs due to excessive hamstring tension during hurdle clearing.

4. Where do most hamstring injuries occur?
a) Muscle belly
b) Musculotendinous junction
c) Fibular head
d) Patellar tendon
Correct answer: b) Musculotendinous junction
Explanation: Most hamstring injuries occur at this junction.

5. What is a tendon avulsion fracture?
a) Muscle tear at the belly
b) Tendon tear with bone fragment detachment
c) Ligament sprain
d) Simple muscle cramp
Correct answer: b) Tendon tear with bone fragment detachment
Explanation: In avulsion fractures, the tendon pulls off a piece of bone.

6. Which athletes are prone to avulsion fractures?
a) Elderly athletes
b) Skeletally immature athletes
c) Middle-aged runners
d) Weightlifters
Correct answer: b) Skeletally immature athletes
Explanation: Avulsion fractures are more common in young, immature skeletons.
7. Which imaging is preferred for hamstring injury diagnosis?
a) X-ray
b) CT scan
c) MRI
d) Ultrasound only
Correct answer: c) MRI
Explanation: MRI provides detailed soft tissue imaging.

8. Which of these is NOT part of the RICE protocol?
a) Rest
b) Ice
c) Elevation
d) Surgery
Correct answer: d) Surgery
Explanation: Surgery is not part of the RICE protocol.

9. What is the role of physiotherapy in hamstring injuries?
a) It delays healing
b) It strengthens and rehabilitates the muscle
c) It replaces surgery
d) It prevents bruising
Correct answer: b) It strengthens and rehabilitates the muscle
Explanation: Physiotherapy supports recovery and muscle strengthening.

10. When is surgery indicated for hamstring injury?
a) Minor strain
b) Complete avulsion with retraction
c) Mild sprain
d) Muscle spasm
Correct answer: b) Complete avulsion with retraction
Explanation: Surgery is indicated when the tendon is fully avulsed and retracted.
11. Which muscle group assists hip extension?
a) Quadriceps
b) Hamstrings
c) Adductors
d) Calf muscles
Correct answer: b) Hamstrings
Explanation: The hamstrings assist with hip extension.
12. What symptom is commonly reported in hamstring tear?
a) Sharp pain with popping sensation

[drbassemkhater]

01:50 : It should be musclo-tendinous junction rather than musclo-cutaneous junction

[thenoobslayer]

I got like type 1 or type 2 and it's been 3 months 😢 In some particular times during this period of time, I almost healed but school activities made it worse. Please help me!

[EfraemBacag]

I'm here because of my IDOL Steph Curry

[jeffreygomes-stsl]

Sincere thank you for your presentation.

[demonbeatz]

I’m here because of the mike evans injury I didn’t know much about hamstring injury’s but now I see they can be pretty bad Mike went down in a lot of pain more then I seen any player with hamstring injury

[mustafijoe]

1:50 musculocutaneous junction--->musculotendinous junction, ,correct

[Ijustscrollforfun]

I got the worst one, it pulled off of my bone and I’m 3 weeks post op

[disschris]

The back of my knee where the calf and hammy connect has been hurting for months

[taylorchan]

Anyone also get a tendon avulsion then search for this video
I find lots of doctor but my case are too rare that they haven’t see a real case before

[robertfreeman]

0:26 nobodies tryna remember all that ..they should just called it hamstring muscle 1, 2 and 3 😂

[thabaninoko]

been 6 months, i don't think i'll be able to play football again 😭😭😭

[dadaignacio]

Im here because step curry is out for the season due to hamstring😮

[DwightSuarez]

I'm here because Steph curry injured

[adityarai]

I suddenly feel discomfort in my hamstring

[AnthonyLabay-ih]

I'm here becoz Steph curry injury

[socire]

i cannot imagine getting this. Looks like hell