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Imaging of hamstring injuries: therapeutic implications

  • Musculoskeletal
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Abstract

Though recent research into the diagnosis and management of hamstring disorders has resulted in early and accurate recognition of injury, hamstring strain remains the most common form of muscle injury in the active population. With prompt recognition of hamstring strain, an appropriate rest and rehabilitation routine may be devised by the sports clinician in the hope of avoiding future and possibly more debilitating injury. As such, imaging has played a pivotal role in assisting athletes, both elite and recreational, in returning to activity expeditiously.

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References

  1. Orchard J, Marsden J, Lord S, Garlick D (1997) Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med 25:81–85

    Article  PubMed  CAS  Google Scholar 

  2. Orchard JW (2001) Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med 29:300–303

    PubMed  CAS  Google Scholar 

  3. Orchard J, Seward H (2002) Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med 36:39–44

    Google Scholar 

  4. Brucker PU, Imhoff AB (2005) Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc 13:411–418

    Article  PubMed  Google Scholar 

  5. Johnson AE, Granville RR, DeBerardino TM (2003) Avulsion of the common hamstring tendon origin in an active duty airman. Mil Med 168:40–42

    PubMed  Google Scholar 

  6. Servant CT, Jones CB (1998) Displaced avulsion of the ischial apophysis: a hamstring injury requiring internal fixation. Br J Sports Med 32:255–257

    Article  PubMed  CAS  Google Scholar 

  7. Koulouris G, Connell D (2003) Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32:582–589

    Article  PubMed  Google Scholar 

  8. Alioto RJ, Browne JE, Barnthouse CD, Scott AR (1997) Complete rupture of the distal semimembranosus complex in a professional athlete. Clin Orthop 336:162–165

    Article  PubMed  Google Scholar 

  9. Koulouris G, Connell D (2005) Hamstring muscle complex: an imaging review. Radiographics 25:571–586

    Article  PubMed  Google Scholar 

  10. Burkett LN (1975) Investigation into hamstring strains: the case of the hybrid muscle. J Sports Med 3:228–231

    Article  PubMed  CAS  Google Scholar 

  11. Beltran J, Matityahu A, Hwang K, Jbara M, Maimon R, Padron M, Mota J, Beltran L, Sundaram M (2003) The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skeletal Radiol 32:435–445

    Article  PubMed  Google Scholar 

  12. Draganich LF, Jaeger RJ, Kralj AR (1989) Coactivation of the hamstrings and quadriceps during extension of the knee. J Bone Joint Surg Am 71:1075–1081

    PubMed  CAS  Google Scholar 

  13. Proske U, Morgan DL, Brockett CL, Percival P (2004) Identifying athletes at risk of hamstring strains and how to protect them. Clin Exp Pharmacol Physiol 31:546–550

    Article  PubMed  CAS  Google Scholar 

  14. Brockett CL, Morgan DL, Proske U (2004) Predicting hamstring strain injury in elite athletes. Med Sci Sports Exerc 36:379–387

    Article  PubMed  Google Scholar 

  15. Dadebo B, White J, George KP (2004) A survey of flexibility training protocols and hamstring strains in professional football clubs in England. Br J Sports Med 38:388–394

    Article  PubMed  CAS  Google Scholar 

  16. Malliaropoulos N, Papalexandris S, Papalada A, Papacostas E (2004) The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up. Med Sci Sports Exerc 36:756–759

    Article  PubMed  Google Scholar 

  17. Braham R, Finch CF, McIntosh A, McCrory P (2004) Community level Australian football: a profile of injuries. J Sci Med Sport 7:96–105

    Article  PubMed  CAS  Google Scholar 

  18. Askling C, Karlsson J, Thorstensson A (2003) Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports 13:244–250

    Article  PubMed  CAS  Google Scholar 

  19. Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM (2002) Hamstring muscle strain recurrence and strength performance disorders. Am J Sports Med 30:199–203

    PubMed  Google Scholar 

  20. Garrett WE Jr, Califf JC, Bassett FH III (1984) Histochemical correlates of hamstring injuries. Am J Sports Med 12:98–103

    Article  PubMed  Google Scholar 

  21. Noonan TJ, Garrett WE Jr (1992) Injuries at the myotendinous junction. Clin Sports Med 11:783–806

    PubMed  CAS  Google Scholar 

  22. Noonan TJ, Garrett WE Jr (1999) Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg 7:262–269

    PubMed  CAS  Google Scholar 

  23. Thelen DG, Chumanov ES, Hoerth DM, Best TM, Swanson SC, Li L, Young M, Heiderscheit BC (2005) Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc 37:108–114

    Article  PubMed  Google Scholar 

  24. Croisier JL (2004) Factors associated with recurrent hamstring injuries. Sports Med 34:681–695

    Article  PubMed  Google Scholar 

  25. Mair SD, Seaber AV, Glisson RR, Garrett WE Jr (1996) The role of fatigue in susceptibility to acute muscle strain injury. Am J Sports Med 24:137–143

    Article  PubMed  CAS  Google Scholar 

  26. Witvrouw E, Danneels L, Asselman P, D’Have T, Cambier D (2003) Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players. A prospective study. Am J Sports Med 31:41–46

    PubMed  Google Scholar 

  27. Sherry MA, Best TM (2004) A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 34:116–125

    Article  PubMed  Google Scholar 

  28. Tadokoro K, Matsui N, Yagi M, Kuroda R, Kurosaka M, Yoshiya S (2004) Evaluation of hamstring strength and tendon regrowth after harvesting for anterior cruciate ligament reconstruction. Am J Sports Med 32:1644–1650

    Article  PubMed  Google Scholar 

  29. Gill SS, Turner MA, Battaglia TC, Leis HT, Balian G, Miller MD (2004) Semitendinosus regrowth: biochemical, ultrastructural, and physiological characterization of the regenerate tendon. Am J Sports Med 32:1173–1181

    Article  PubMed  Google Scholar 

  30. Brandser EA, el-Khoury GY, Kathol MH, Callaghan JJ, Tearse DS (1995) Hamstring injuries: radiographic, conventional tomographic, CT, and MR imaging characteristics. Radiology 197:257–262

    PubMed  CAS  Google Scholar 

  31. Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A (2004) The Football Association medical research programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med 38:36–41

    Article  PubMed  CAS  Google Scholar 

  32. Kirkendall DT, Garrett WE Jr (2002) Clinical perspectives regarding eccentric muscle injury. Clin Orthop Relat Res (403 Suppl):S81–S89

  33. Taylor DC, Dalton JD Jr, Seaber AV, Garrett WE Jr (1993) Experimental muscle strain injury. Early functional and structural deficits and the increased risk for reinjury. Am J Sports Med 21:190–194

    Article  PubMed  CAS  Google Scholar 

  34. Taylor MA, Norman TL, Clovis NB, Blaha JD (2002) The response of rabbit patellar tendons after autologous blood injection. Med Sci Sports Exerc 34:70–73

    Article  PubMed  Google Scholar 

  35. Garrett WE Jr, Nikolaou PK, Ribbeck BM, Glisson RR, Seaber AV (1988) The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. Am J Sports Med 16:7–12

    Article  PubMed  Google Scholar 

  36. Speer KP, Lohnes J, Garrett WE Jr (1993) Radiographic imaging of muscle strain injury. Am J Sports Med 21:89–95; discussion 96

    Article  PubMed  CAS  Google Scholar 

  37. Bush CH (2000) The magnetic resonance imaging of musculoskeletal hemorrhage. Skeletal Radiol 29:1–9

    Article  PubMed  CAS  Google Scholar 

  38. Connell DA, Schneider-Kolsky ME, Hoving JL, Malara F, Buchbinder R, Koulouris G, Burke F, Bass C (2004) Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. Am J Roentgenol 183:975–984

    Google Scholar 

  39. Gibbs NJ, Cross TM, Cameron M, Houang MT (2004) The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. J Sci Med Sport 7:248–258

    Article  PubMed  CAS  Google Scholar 

  40. De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. Am J Roentgenol 174:393–399

    Google Scholar 

  41. Sofka CM, Collins AJ, Adler RS (2001) Use of ultrasonographic guidance in interventional musculoskeletal procedures: a review from a single institution. J Ultrasound Med 20:21–26

    PubMed  CAS  Google Scholar 

  42. Oseto MC, Edwards JZ, Acus RW III (2004) Posterior thigh compartment syndrome associated with hamstring avulsion and chronic anticoagulation therapy. Orthopedics 27:229–230

    PubMed  Google Scholar 

  43. Nikolaou PK, Macdonald BL, Glisson RR, Seaber AV, Garrett WE Jr (1987) Biomechanical and histological evaluation of muscle after controlled strain injury. Am J Sports Med 15:9–14

    Article  PubMed  CAS  Google Scholar 

  44. Garrett WE Jr (1990) Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc 22:436–443

    PubMed  Google Scholar 

  45. Chan YS, Li Y, Foster W, Fu FH, Huard J (2005) The use of suramin, an antifibrotic agent, to improve muscle recovery after strain injury. Am J Sports Med 33:43–51

    Article  PubMed  Google Scholar 

  46. Pomeranz SJ, Heidt RS Jr (1993) MR imaging in the prognostication of hamstring injury. Work in progress. Radiology 189:897–900

    PubMed  CAS  Google Scholar 

  47. Levine WN, Bergfeld JA, Tessendorf W, Moorman CT III (2000) Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med 28:297–300

    PubMed  CAS  Google Scholar 

  48. Beiner JM, Jokl P (2001) Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg 9:227–237

    PubMed  CAS  Google Scholar 

  49. Beyth S, Liebergall M, Mosheiff R (2002) Myositis ossificans circumscripta of the sacrotuberous ligament: a case report and review of the literature. J Orthop Trauma 16:672–674

    Article  PubMed  Google Scholar 

  50. Giombini A, Di Cesare A, Sardella F, Ciatti R (2003) Myositis ossificans as a complication of a muscle tendon junction strain of long head of biceps. A case report. J Sports Med Phys Fitness 43:75–77

    PubMed  CAS  Google Scholar 

  51. Parikh J, Hyare H, Saifuddin A (2002) The imaging features of post-traumatic myositis ossificans, with emphasis on MRI. Clin Radiol 57:1058–1066

    Article  PubMed  CAS  Google Scholar 

  52. Ledermann HP, Schweitzer ME, Morrison WB (2002) Pelvic heterotopic ossification: MR imaging characteristics. Radiology 222:189–195

    Article  PubMed  Google Scholar 

  53. Beiner JM, Jokl P (2002) Muscle contusion injury and myositis ossificans traumatica. Clin Orthop Relat Res (403 Suppl):S110–S119

  54. Jackson DW, Feagin JA (1973) Quadriceps contusions in young athletes. Relation of severity of injury to treatment and prognosis. J Bone Joint Surg Am 55:95–105

    PubMed  CAS  Google Scholar 

  55. Kocis J, Visna P, Vesely R (2003) Traumatic avulsion of the tuberosity of the ischium. Acta Chir Orthop Traumatol Cechoslov 70:311–313

    CAS  Google Scholar 

  56. Rossi F, Dragoni S (2001) Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol 30:127–131

    Article  PubMed  CAS  Google Scholar 

  57. Varela JR, Rodriguez E, Soler R, Gonzalez J, Pombo S (2000) Complete rupture of the distal semimembranosus tendon with secondary hamstring muscles atrophy: MR findings in two cases. Skeletal Radiol 29:362–364

    Article  PubMed  CAS  Google Scholar 

  58. Orava S, Kujala UM (1995) Rupture of the ischial origin of the hamstring muscles. Am J Sports Med 23:702–705

    Article  PubMed  CAS  Google Scholar 

  59. Sallay PI, Friedman RL, Coogan PG, Garrett WE (1996) Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med 24:130–136

    Article  PubMed  CAS  Google Scholar 

  60. Blasier RB, Morawa LG (1990) Complete rupture of the hamstring origin from a water skiing injury. Am J Sports Med 18:435–437

    Article  PubMed  CAS  Google Scholar 

  61. Holmstrom MC, Greis PE, Horwitz DS (2003) Chronic ischial apophysitis in a gymnast treated with transapophyseal drilling to effect “apophysiodesis”. A case report. Am J Sports Med 31:294–296

    PubMed  Google Scholar 

  62. Yamamoto T, Akisue T, Nakatani T, Kawamoto T, Hitora T, Marui T, Kurosaka M (2004) Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging. Skeletal Radiol 33:737–740

    Article  PubMed  Google Scholar 

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Correspondence to David Connell.

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Koulouris, G., Connell, D. Imaging of hamstring injuries: therapeutic implications. Eur Radiol 16, 1478–1487 (2006). https://doi.org/10.1007/s00330-005-0075-3

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