Proximal Hamstring Tendon Tear

What and where are the hamstrings?

The proximal hamstrings are a group of three muscles located at the back of your thigh (posterior.) They run from your pelvis (ischial tuberosity) down to your shin bones (tibia and fibula). These are called:

• Long head of the biceps femoris tendon
• Semitendinosus tendon
• Semimembranosus tendon

The job of these muscles and tendon attachments is to bend the knee and straighten the hip with activities such as squatting, walking, and climbing stairs.

What is a proximal hamstring tendon tear?

The proximal hamstring tendons are composed of three thick, short tendons that attach the muscles in the back of the thigh to the ischial tuberosity (sitting bone.) A tear of this tendon means the tendon has either pulled off of the bone, or the tendon itself has ruptured (torn partially or completely in half.) These tears can occur either suddenly in a dramatic fashion, causing severe bruising, or persistently over a long period of time. Doctor Prem Ramkumar specializes in diagnosing and treating proximal hamstring tears for patients in Long Beach, Los Angeles, Orange County, and surrounding Southern California areas.

What are the symptoms of a proximal hamstring tear or injury?

Hamstring injuries can be very painful, with pain felt primarily in the back of the leg. Other symptoms include:

• Swelling in the back of the leg
• Bruising
• Weakness in the leg
• Sharp, sudden pain in the back of the thigh
• Throbbing, cramping or burning in the back of the thigh
• Pain felt deep in the buttocks
• Pain that worsens with activity

Who is susceptible to a hamstring injury or tear?

Athletes and non-athletes can be susceptible to a hamstring injury. Dr. Ramkumar sees a lot of individuals with hamstring injuries who are involved in sports that involve running, jumping, starting, and stopping quickly. Repetitive use of the hamstrings in physical activities can cause inflammation which can predispose the tendon to injury. Patients may also experience a “freak accident” where their leg is forcefully straightened with tremendous force, causing the rupture.

How is a proximal hamstring injury diagnosed?

Dr. Ramkumar will obtain a thorough history and conduct an exam, including questions about activities leading up to the injury. He will check for any visible bruising and swelling in the injured leg and may order an X-ray if he suspects bone involvement. An MRI may also be performed to determine the extent of injury and to classify the grade of injury.

How is a proximal hamstring injury graded?

The severity of a hamstring is classified by grade:

• Grade 1: A hamstring pull or sprain where the tendon and muscle are still intact. The muscle may have been stretched too far and often muscle spasms are present
• Grade 2: A moderate strain or sprain of the muscle with tearing of the muscle fibers (fraying). Grade 2 hamstring injuries affect walking and often show bruising. These injuries are tender to simple palpation.
• Grade 3: A complete tear in one or more of the muscle/tendon groups. Walking is often extremely difficult and bruising with swelling begins immediately at the time of injury. Grade 3 tears often require surgery to repair the injury

The nature of the proximal hamstrings are also characterized by the number of tendons involved and the degree of retraction. If the patient wants to return to higher impact activities, typically tears that are more than 2cm retracted or involve two to three tendons are concerning.

What is the treatment for a proximal hamstring injury or tear?

The type of treatment for a proximal hamstring injury depends on the number of tendons involved, the degree of retraction, and the patient’s goals. Sometimes, a violent hamstring rupture can cause electric shocks and numbness due to sciatic nerve involvement given the proximity of this nerve to the hamstring tendons.

Non-Surgical:

Grade 1 and 2 tears are considered mild to moderate muscle strains that may affect weight-bearing ability. Most hamstring injuries fall in these two categories and are often able to be treated with conservative therapies alone. Dr. Ramkumar prescribes a combination of RICE (rest, ice, compression, elevation), immobilization, and non-steroidal anti-inflammatory medications (NSAIDs) for pain and inflammation management. Physical therapy when appropriate is often highly encouraged to help heal and to strengthen supporting muscles.

Surgical:

Surgery is often recommended for the following:

• Grade 3 tears: Tears involving a complete rupture of all 3 hamstring muscles originating from the ischial tuberosity (called an avulsion tear)
• Two hamstring tendons showing a retraction of at least 2cm
• Failure of conservative therapy for a lesser grade tear
• The patient desires high demand activities