Proximal Hamstrings Repair
Overview
The hamstrings are a group of three muscles located in the back of the thigh: the semimembranosus, semitendinosus, and biceps femoris. These muscles are responsible for flexing the knee and extending the hip. The hamstrings originate at the ischial tuberosity (sit bones) of the pelvis and insert on the tibia (shinbone) and the head of the fibula (smaller bone in the leg)
Proximal hamstring tears are a type of injury that occurs when the tendons at the top of the hamstring muscle group are damaged. Proximal hamstring tears can be caused by a variety of factors, including overuse, muscle imbalance, and trauma.
Symptoms
Those with a proximal hamstring tear may have pain at the top of the leg, difficulty moving the leg, swelling, and bruising. These symptoms may be more pronounced when attempting to walk, run, or engage in other physical activities. With more complete tears, a very pronounced and severe bruising will occur below the buttocks and running down the back of the thigh.
Diagnosis
These injuries are sometimes missed because they can often be mistaken for other muscle or joint injuries, such as a muscle strain.
To diagnose a proximal hamstring rupture, an orthopedic surgeon will typically begin with a thorough physical examination. During the examination, the surgeon will assess the range of motion in the leg and hip, and will look for signs of swelling, bruising, and tenderness. The surgeon may also ask the patient to perform certain movements, such as walking or attempting to lift the leg, to help determine the severity of the injury.
Imaging tests, such as an MRI or ultrasound, can also be useful in diagnosing a proximal hamstring rupture. These tests can provide detailed images of the muscle tissue and can help the surgeon identify any tears or other abnormalities.
It is important to seek medical attention as soon as possible if you suspect that you may have a proximal hamstring rupture. Early diagnosis and treatment can help prevent further damage and can help speed up the healing process. For large, complete, retracted tears, early intervention has been shown to lead to better results.
Treatment of Partial Tears
- Stretching and strengthening exercises to improve flexibility and muscle strength
- My favorite strengthening exercise for the hamstrings is the 'Nordic hamstrings curl'
- Massage and other manual therapy techniques to reduce inflammation and improve blood flow
- Use of heat or cold therapy to reduce pain and swelling
- Electrical stimulation to promote muscle healing
- Gradual return to activities, starting with low-impact exercises and gradually increasing intensity
- Education on proper body mechanics and techniques to prevent re-injury
- Modification of daily activities as needed to accommodate healing and prevent further strain on the muscles
- Use of assistive devices, such as crutches or a cane, to help with mobility during the recovery process
- PRP injections into the injury site can help with healing.
surgical management
Surgery may be necessary for proximal hamstring tears that are severe or that do not respond to non-surgical treatment methods. I recommend surgery for all proximal hamstrings tears with more than 2 centimeters of retraction, complete (3 tendon), and some two tendon tears. The goal of surgery is to repair the damaged tissue and restore function to the leg. The timing of surgery is extremely important; when repaired within the first 4-6 weeks from injury it is much easier to identify and mobilize the torn tendon. After 6 weeks there is typically already a robust healing response and dense scar tissue forms between the torn tendon and surrounding structures.
There are several different surgical options for proximal hamstring tears, and the specific procedure used will depend on the severity and location of the tear. In general, I make a small 5cm incision in the lower buttocks skin fold, locate the retracted tendon, and reattach the tendon to the pelvic ischium bone using suture anchors. Surgery takes about 90 minutes, and is done on an outpatient basis (you go home same day). Patients are made partial weight bearing with crutches for four weeks and usually do not require a special brace.
Recovery from surgery for a proximal hamstring tear can be a long process, and it is important to follow instructions and adhere to a rehabilitation plan to ensure the best possible outcome. Physical therapy will typically be a key component of the recovery process, and may include stretching and strengthening exercises, as well as modalities such cold therapy. A return to running will take 3-4 months, with a full recovery taking up to 6 months.
It is also important to take precautions to prevent re-injury during the recovery process. This may include avoiding certain activities, such as running or jumping, until the surgeon gives permission to resume these activities. It may also be necessary to modify daily activities, such as carrying heavy objects or climbing stairs, to reduce strain on the leg.
In most cases, surgery for a proximal hamstring tear is successful in restoring function to the leg and helping the patient return to their normal activities. However, it is important to keep in mind that every patient is different, and the specific recovery timeline and outcome will depend on a variety of factors.
Proximal Hamstrings Surgery in Salem, Oregon
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing proximal hamstrings repair and hip arthroscopy in the Willamette Valley.