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Proximal Hamstring Tendinopathy
From WikiSM
Contents
Other Names
- Hamstring Tendinopathy
- Hamstring Tendinosis
- Proximal Hamstring Tendinopathy (PHT)
- Hamstring Origin Tendinopathy
- High Hamstring Tendinopathy
Background
- This page refers to subacute and chronic Hamstring Tendinopathies (HT)
- Most commonly, this refers to Proximal Hamstring Tendinopathy (PHT)
- Acute Hamstring Strains and Tears are a distinct clinical entities discussed separately
History
- Needs to be updated
Epidemiology
- The epidemiology of PHT is poorly described in the literature and currently unknown
Pathophysiology
- See: Tendinopathies (Main)
- Location
- Proximal Hamstring Tendinopathy
- Most common location overall for tendinopathies of the hamstring muscle
- Considered to be an insertional tendinopathy
- Compression can occur at insertion during hip flexion, abduction[3]
Pathoanatomy
- Hamstring Muscle Group
- Composed of Biceps Femoris, Semimimembranosis, Semitendinosis
- Biarticular muscle group performs hip extension, knee flexion
- Histopathology
- Biopsy shows increased cellularity, ground substance accumulation, collagen disorganization, and neurovascular ingrowth[4]
Associated Conditions
- Sciatica
- Can co-occur with fibrosis entrapment of the Sciatic Nerve between the Ischial Tuberosity and Semimimembranosis
Risk Factors
- General
- Sports
- Running
- Track and field, especially sprinters and hurdlers
- Hockey
- Football
Differential Diagnosis
- Fractures
- Muscle and Tendon
- Neurological
- Other
Clinical Features
- History
- Pain is typically insidious, no trauma is endorsed
- Patient will report lower gluteal pain, sometimes radiating to posterior thigh
- Worse with prolonged periods of sitting, running at a fast pace, jumping
- The patient may have a history of repetitive hamstring injuries
- Pain will radiate down hamstrings
- Physical Exam: Physical Exam Hip
- Palpable tenderness along the Ischial Tuberosity, worse with resisted knee flexion
- Active or passive stretching can make symptoms worse
- Special Tests
- Puranen Orava Test: Hip flexed to 90°, knee extended and leg placed on exam table, patient reaches for toes
- Bent Knee Stretch Test: Patient supine, hip and knee maximally flexed, knee is slowly extended
- Modified Bent Knee Stretch Test: similar to bent knee stretch test except knee is rapidly extended
Evaluation
Radiographs
- Standard Radiographs Hip
- Screening tool, typically normal
Ultrasound
- Advantages
- Readily available
- Cost-effective imaging technique
- Allows dynamic evaluation
- Excellent screening tool prior to obtaining an MRI
MRI
- Advantages
- Better tissue contrast
- More sensitive than US in detecting tendinopathy, peritendinous edema[5]
Classification
- Not applicable
Management
Prognosis
- Time to full recovery is typically 1 - 3 months[6]
- Good results have been demonstrated with full return to pre-injury sports level
- Lempainen et al on surgical intervention[1]
- They found that 80 of 90 athletes reported to the same level of competition with low complication rates following surgery
- This was after a mean of 5 months (range 2-12)
Nonoperative
- Most cases can successfully be treated nonoperatively
- Acute Phase
- Reduction or cessation from offending activities
- NSAIDS
- Ice Therapy
- Consider non-weight bearing status
- Physical Therapy
- Emphasis on load management, biomechanics
- Emphasis on eccentric hamstring strengthening
- Adjunct core strength and stabilizing
- Lumbopelvic Stabilization Exercises
- Corticosteroid Injection
- Platelet Rich Plasma
- Extracorporeal Shockwave Therapy (ESWT)
- Cachio et al found ESWT superior to usual care for pain reduction at a mean of 10.7 months[11]
- Soft Tissue Mobilization
- Trigger Point Injection or Dry Needling
- Proprioceptive Training shown to be beneficial for neuromuscular control[12]
Operative
- Indications
- Failure of conservative management for an interterminant amount of time, typically at least 6 months
- Technique
- Semimembranosus tenotomy and exploration of the sciatic nerve
Rehab and Return to Play
Rehabilitation
- One proposed protocol by gooms et al[13]
- Stage 1: Isometric hamstring load
- Stage 2: Isotonic hamstring load with minimal hip flexion
- Stage 3: Isotonic exercises in increased hip flexion (70° - 90°)
- Stage 4: Energy storage loading
Return to Play
- Should be gradually introduced to athlete as their pain and function improve
- Important to avoid risk of re-injury
- Progressive should be step-wise under the care of AT or PT
Complications
- Re-injury
- Inability to return to sport
- Chronic pain
See Also
- Internal
- External
- https://www.sportsmedreview.com/blog/chronic-hamstring-tendinopathy-review/
- Sports Medicine Review Hip Pain: https://www.sportsmedreview.com/by-joint/hip/
References
- ↑ 1.0 1.1 Lempainen, Lasse, et al. "Proximal hamstring tendinopathy: results of surgical management and histopathologic findings." The American journal of sports medicine 37.4 (2009): 727-734.
- ↑ .Benazzo F, Marullo M, Zanon G, Indino C, Pelillo F. Surgical management of chronic proximal hamstring tendinopathy in athletes: a 2 to 11 years of follow-up. J Orthop Traumatol. 2013;14:83-89
- ↑ Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46:163-168
- ↑ Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 2009;37:727-734
- ↑ Zissen MH, Wallace G, Stevens KJ, Fredericson M, Beaulieu CF. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol. 2010;195(4):993–998.
- ↑ Lempainen, Lasse, et al. "Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy." Muscles, ligaments and tendons journal 5.1 (2015): 23.
- ↑ Levine, William N., et al. "Intramuscular corticosteroid injection for hamstring injuries: a 13-year experience in the National Football League." The American journal of sports medicine 28.3 (2000): 297-300.
- ↑ Nicholson, Luke T., et al. "Fluoroscopically guided peritendinous corticosteroid injection for proximal hamstring tendinopathy: a retrospective review." Orthopaedic journal of sports medicine 2.3 (2014): 2325967114526135.
- ↑ Wetzel, Robert J., Ronak M. Patel, and Michael A. Terry. "Platelet-rich plasma as an effective treatment for proximal hamstring injuries." Orthopedics 36.1 (2013): e64-e70.
- ↑ Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, Dharamsi AS, et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013;5(3):169–175
- ↑ Cacchio, Angelo, et al. "Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes." The American journal of sports medicine 39.1 (2011): 146-153.
- ↑ White KE. High hamstring tendinopathy in 3 female long distance runners. J Chiropr Med. 2011;10(2):93–99.
- ↑ Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016 Jun;46(6):483-93
Created by:
John Kiel on 11 June 2019 01:57:19
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Last edited:
5 October 2022 13:07:29
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