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Hamstring Injury Workup

  • Author: Herman Brad Ruiz, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Oct 22, 2015
 

Laboratory Studies

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  • 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.

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Resource Centers Pathology & Lab Medicine

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Imaging Studies

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  • 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.
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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 outcome[10] ; 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]

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Resource Center Pain Management: Advanced Approaches to Chronic Pain Management

Resource Center Pain Management: Pharmacologic Approaches

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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, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Pain Society, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

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, 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

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

References
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  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. 2008 Jun. 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. 1996 Mar-Apr. 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. 2008 Apr 30. epub ahead of print. [Medline].

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

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  9. Hoskins W, Pollard H. The management of hamstring injury-- part 1: issues in diagnosis. Man Ther. 2005 May. 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. 2000 May-Jun. 28(3):297-300. [Medline].

  11. Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med. 2011 Apr. 39(4):843-50. [Medline].

  12. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013 Mar 27. [Medline].

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  14. Malliaropoulos N, Isinkaye T, Tsitas K, Maffulli N. Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med. 2011 Feb. 39(2):304-10. [Medline].

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  16. Opar DA, Williams MD, Timmins RG, Dear NM, Shield AJ. Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings. Am J Sports Med. 2013 Jan. 41 (1):116-25. [Medline].

  17. Bucknor MD, Steinbach LS, Saloner D, Chin CT. Magnetic resonance neurography evaluation of chronic extraspinal sciatica after remote proximal hamstring injury: a preliminary retrospective analysis. J Neurosurg. 2014 Aug. 121 (2):408-14. [Medline].

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

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

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

  21. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer: A Cluster-Randomized Controlled Trial. Am J Sports Med. 2011 Nov. 39(11):2296-303. [Medline].

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