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Review
. 2019 Jun;12(2):138-146.
doi: 10.1007/s12178-019-09541-x.

Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries

Ryan M Degen  1
Affiliations
Review

Proximal Hamstring Injuries: Management of Tendinopathy and Avulsion Injuries

Ryan M Degen. Curr Rev Musculoskelet Med. 2019 Jun.

Abstract

Purpose of review: To outline the typical presentation, physical examination, diagnostic imaging, and therapeutic treatment options for proximal hamstring injuries to improve awareness, expedient diagnosis, and definitive management.

Recent findings: Proximal hamstring tendinopathy and partial-thickness tears can often successfully be managed with a combination of non-operative modalities, including physiotherapy focused on eccentric strengthening, extracorporeal shock wave therapy, or peri-tendinous injections. Surgery is reserved for refractory cases, but can yield good outcomes. Contrastingly, non-operative treatment often leads to unsatisfactory outcomes in complete ruptures, with residual weakness and reduced function with poor return-to-sport rates. Instead, surgical repair can provide satisfactory outcomes, with good-to-excellent functional outcomes and strength, with acute treatment preferred over delayed, chronic repair. Hamstring tendinopathy and partial-thickness tears can be successfully treated non-operatively with good functional outcomes, with surgical repair reserved for refractory cases. Complete tears are best managed with surgical repair, allowing improved strength and functional outcomes.

Keywords: Avulsion injuries; Hamstring injuries; Orthopedics; Outcomes research; Tendinopathy.

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Conflict of interest statement

Ryan M. Degen declares no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Puranen-Orava test for hamstring tendinopathy
Fig. 2
Fig. 2
Bent-knee stretch test for hamstring tendinopathy
Fig. 3
Fig. 3
Standing heel drag test for hamstring tendinopathy
Fig. 4
Fig. 4
Popliteal angle
Fig. 5
Fig. 5
“Sickle sign” demonstrating partial-thickness hamstring tear of the proximal origin. a Coronal T2-weighted MRI image. b Axial T2-weighted MRI image
Fig. 6
Fig. 6
Coronal T2-weighted MRI demonstrating a complete proximal avulsion injury with 4 cm of distal retraction
Fig. 7
Fig. 7
Intra-operative image after sciatic neurolysis and tendon mobilization
Fig. 8
Fig. 8
Post-operative radiograph demonstrating the author’s preferred anchor configuration
See this image and copyright information in PMC

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