Anatomy
The hamstrings consist of 4 muscles (semimembranosus, semitendinosus, and the short and long head of the biceps femoris). A muscle is attached to bone with a tendon. Where the muscles attach up by the hip is called the origin while down by the knee it’s called the insertion. With the exception of the short head of the biceps femoris, the other three tendons originate from the ischial tuberosity (part of the pelvis that some people refer to as the sit bone). The semitendinosus and biceps femoris are referred to as the conjoint tendon and originate more medial (more midline) on the ischial tuberosity while the semimembranosus has the most lateral attachment.
What is a Proximal Hamstring Tear?
Proximal hamstring tears can either happen from a particular incident (such as water skiing, running, kicking, or jumping) or may be more chronic in nature and developed slowly over time. A proximal hamstring tears occurs when there is an injury to the origin (the back side of the hip) of the hamstring tendons which results in either a partial or complete tear of the hamstring tendon from the bone.
Symptoms of Proximal Hamstring Tears
- Pain in the back of the thigh
- Occasionally a “pop” is felt in acute injuries
- Hamstring tightness
- Pain with sitting in the back of the thigh in particular with firm chairs
- May have bruising in the back of the thigh
- Occasionally a palpable mass is felt in the back of the thigh
- Avoiding knee and hip flexion, known as “stiff-legged” gait
Diagnosing Proximal Hamstring Tears
A thorough patient history and physical exam can help to identify patients with proximal hamstring injuries and imaging studies including x-rays and MRI are used to help confirm the diagnosis and determine the extent of the tear.
Treatment for Proximal Hamstring Tears
Nonsurgical options:
- Activity modifications and rest including protected weightbearing
- Anti-inflammatory medications
- Physical therapy
- PRP injections
Surgery:
- Tendon repair, or in the setting of bony avulsion of the tendon insertions, fixation of the bony fragment