eMedicine Specialties > Sports Medicine > Lower Limb

Hamstring Injury: Differential Diagnoses & Workup

Author: Herman Brad Ruiz, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Division of Orthopedics and Rehabilitation, Loyola University Medical School at Illinois
Coauthor(s): Syed M Zaffer, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Northwestern University
Contributor Information and Disclosures

Updated: Jun 16, 2008

Differential Diagnoses

Lumbosacral Facet Syndrome
Lumbosacral Radiculopathy
Sacroiliac Joint Injury

Other Problems to Be Considered

Apophysitis
Chronic hamstring syndrome
Ischial bony avulsion

Workup

Laboratory Studies

  • Laboratory studies are typically not needed to make the diagnosis of hamstring injury. Most often, a diagnosis can be made with the history and physical examination alone.

Related Medscape topic:
Resource Centers Pathology & Lab Medicine

Imaging Studies

  • In most cases, imaging studies have no role in the workup of hamstring injuries.
    • Radiographs of the pelvis can be negative even though the patient may have a bony avulsion. However, radiographs may reveal calcifications that may be present in patients with chronic hamstring pain.
    • Ultrasound or magnetic resonance imaging (MRI) studies 2-3 days postinjury may be recommended to rule out total muscular rupture or an intramuscular hematoma if significant weakness is still present.
    • An MRI is often ordered to help clinicians prepare for possible surgery if radiographs reveal a gross deformity.

Procedures

  • Past treatment options for acute hamstring injuries included intramuscular corticosteroids; however, given the evidence of delayed healing in acute muscle injury as well as muscle atrophy, this treatment could have detrimental effects over the long term. In a retrospective study of the use of intramuscular corticosteroid injection for hamstring injuries in professional football players, Levine et al found that players with a partial hamstring tear had no ill effects of the corticosteroid injection in terms of functional outcome10 ; however, the follow-up time frame was not clearly defined. Although this study does not address the issue of the physiologic effects of corticosteroids in muscle injury, it does offer some initial clinical outcomes for this procedure in athletes.10

Related eMedicine topics:
Corticosteroid Injections of Joints and Soft Tissues
Therapeutic Injections for Pain Management

Related Medscape topics:
Resource Center Pain Management: Advanced Approaches to Chronic Pain Management
Resource Center Pain Management: Pharmacologic Approaches

More on Hamstring Injury

Overview: Hamstring Injury
Differential Diagnoses & Workup: Hamstring Injury
Treatment & Medication: Hamstring Injury
Follow-up: Hamstring Injury
References
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References

  1. Davis KW. Imaging of the hamstrings. Semin Musculoskelet Radiol. Mar 2008;12(1):28-41. [Medline].

  2. Reid DC. Soft tissue injuries of the thigh. Sports Injury Assessment and Rehabilitation. Philadelphia, Pa: Churchill Livingstone; 1992:551-71.

  3. Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med. Jun 2008;36(6):1110-5. [Medline].

  4. Sallay PI, Friedman RL, Coogan PG, Garrett WE. Hamstring muscle injuries among water skiers. Functional outcome and prevention. Am J Sports Med. Mar-Apr 1996;24(2):130-6. [Medline].

  5. Askling CM, Tengvar M, Saartok T, Thorstensson A. Proximal hamstring strains of stretching type in different sports: injury situations, clinical and magnetic resonance imaging characteristics, and return to sport. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].

  6. Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. Apr 30 2008;epub ahead of print. [Medline].

  7. Clark RA. Hamstring injuries: risk assessment and injury prevention. Ann Acad Med Singapore. Apr 2008;37(4):341-6. [Medline]. [Full Text].

  8. Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. Jul-Aug 1998;6(4):237-48. [Medline].

  9. Hoskins W, Pollard H. The management of hamstring injury-- part 1: issues in diagnosis. Man Ther. May 2005;10(2):96-107. [Medline].

  10. Levine WN, Bergfeld JA, Tessendorf W, Moorman CT 3rd. Intramuscular corticosteroid injection for hamstring injuries. A 13-year experience in the National Football League. Am J Sports Med. May-Jun 2000;28(3):297-300. [Medline].

  11. Kujala UM, Orava S, Järvinen M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. Jun 1997;23(6):397-404. [Medline].

  12. Unger CL, Unger DA. Preventing and rehabilitating hamstring injuries. Athl Ther Today. May 1997;44-9.

  13. Worrell TW. Factors associated with hamstring injuries. An approach to treatment and preventative measures. Sports Med. May 1994;17(5):338-45. [Medline].

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Further Reading

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Keywords

hamstring strain, hamstring pull, lower extremity injury, lower-extremity injury

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Contributor Information and Disclosures

Author

Herman Brad Ruiz, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Division of Orthopedics and Rehabilitation, Loyola University Medical School at Illinois
Herman Brad Ruiz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Syed M Zaffer, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Northwestern University
Syed M Zaffer, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, North American Primary Care Research Group, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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