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Review
. 2015 Mar 27;5(1):23-8.
eCollection 2015 Jan-Mar.

Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy

Lasse Lempainen  1 , Kristian Johansson  2 , Ingo J Banke  3 , Juha Ranne  1 , Keijo Mäkelä  4 , Janne Sarimo  1 , Pekka Niemi  1 , Sakari Orava  1
Affiliations
Review

Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy

Lasse Lempainen et al. Muscles Ligaments Tendons J. .

Abstract

Background: proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting. Mainly affecting athletically active individuals, PHT is a considerable challenge for treating health care professionals.

Purpose: this paper aims to concisely present the literature on PHT to guide health care professionals treating these patients and doing research on the subject.

Methods: we reviewed the literature on PHT through literature search of scientific journal databases.

Conclusions: as a tendinopathic pathology, it is a rather recently discovered exertion injury. As with other chronic tendon overuse injuries, current treatment strategies are unspecific with uncertain outcomes due to the unknown etiology of the tendon degeneration. Diagnostic features as well as both operative and non-operative treatments are evaluated from a clinical perspective, providing up to date information for clinicians and sports medicine therapists dealing with hamstring problems.

Level of evidence: V.

Keywords: exertion injury; hamstring; tendinopathy; treatment.

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Figures

Figure 1 A–C.
Figure 1 A–C.
MR images of a 24-year-old long-distance runner with the chronic PHT on the right side. (A) Axial STIR image (TR=3080ms, TE=60ms) shows peritendinous edema (arrow head) and bone marrow edema-like changes (asterisk). (B) Axial T1-weighted FSE image (TR=525ms, TE=20ms) shows intratendinous signal changes and thickening of the hamstring tendons (arrow head). (C) Coronal T2-weighted fat suppressed FSE image (TR=3675ms, TE=40ms) shows peritendinous (arrow heads) and bone marrow edema-like changes (asterisk).
Figure 2.
Figure 2.
A schematic drawing of the right hamstring muscle anatomy. The semimembranosus tendon (SM) is related anteriorly to the biceps femoris muscle (BF). The sciatic nerve (SN) curves lateral side of the ischial tuberosity (IT). The semitendinosus muscle (ST) is medial to the BF. In this figure the lateral edge of the BF is pulled medially to expose the thickened and edematous SM tendon.
Figure 3.
Figure 3.
Tenotomy is performed to the lateral side of the SM tendon and the sciatic nerve gently explored.
Figure 4.
Figure 4.
The distal head of the tenotomized SM tendon sutured to the BF tendon.
See this image and copyright information in PMC

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