Imaging of the Hamstrings

ABSTRACT

The hamstring muscles, located in the posterior thigh, include the biceps femoris, the semimembranosus, and the semitendinosus. The proximal portions of the hamstring muscles are subject to a variety of injuries and pathology. Many of these entities affect the origin of the hamstrings, including the tendinous enthesis, the underlying ischial tuberosity, and the surrounding tissues. Tendinosis and small partial tears at the origin are the result of chronic attrition. They may be accompanied by bursitis or hamstring syndrome. Apophysitis occurs in teenagers prior to complete fusion of the ischial apophysis and results from repeated traction injuries on the apophysis without discrete displacement. Abrupt injury at the origin from forced flexion of the hip results in osseous avulsions of the apophysis in teenagers and proximal tendon ruptures in adults. Other entities affect the muscles distal to the tendon origins. These injuries include strains and partial tears of the musculotendinous junction from acute indirect trauma, delayed onset muscle soreness from overuse of the muscle group without discrete remembered injury, and contusions and myositis ossificans from direct blunt impact. The imaging features of these injuries and pathology are fairly specific and diagnostic, with the exception of some cases of myositis ossificans and chronic ischial avulsions.

KEYWORDS

Hamstrings - semimembranosus - semitendinosus - biceps femoris - muscle injury - pelvis - magnetic resonance imaging

REFERENCES

• 1 Koulouris G, Connell D. Hamstring muscle complex: an imaging review.  Radiographics. 2005;  25 571-586
• 2 Kujala U M, Orava S, Jarvinen M. Hamstring injuries: current trends in treatment and prevention.  Sports Med. 1997;  23 397-404
• 3 Clanton T O, Coupe K J. Hamstring strains in athletes: diagnosis and treatment.  J Am Acad Orthop Surg. 1998;  6 237-248
• 4 Bencardino J T, Mellado J M. Hamstring injuries of the hip.  Magn Reson Imaging Clin N Am. 2005;  13 677-690
• 5 Miller S L, Gill J, Webb G R. The proximal origin of the hamstrings and surrounding anatomy encountered during repair.  J Bone Joint Surg. 2007;  89 44-48
• 6 Koulouris G, Connell D. Imaging of hamstring injuries: therapeutic implications.  Eur Radiol. 2006;  16 1478-1487
• 7 Munshi M, Pretterklieber M L, Kwak S et al.. MR Imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study.  AJR Am J Roentgenol. 2003;  180 1095-1101
• 8 Garrett Jr W E, Rich F R, Nikolaou P K, Vogler III J B. Computed tomography of hamstring muscle strains.  Med Sci Sports Exerc. 1989;  21 506-514
• 9 Connell D, Schneider-Kolsky M E, Hoving J L et al.. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries.  AJR Am J Roentgenol. 2004;  183 975-984
• 10 Palmer W E, Kuong S J, Elmadbouh H M. MR imaging of myotendinous strain.  AJR Am J Roentgenol. 1999;  173 703-709
• 11 Markee J E, Logue J T, Williams M et al.. Two-joint muscles of the thigh.  J Bone Joint Surg Am. 1955;  37-A 125-142
• 12 Jonhagen S, Nemeth G, Eriksson E. The role of concentric and eccentric hamstring muscle strength and flexibility.  Am J Sports Med. 1994;  22 262-266
• 13 Brockett C L, Morgan D L, Proske U. Predicting hamstring strain injury in elite athletes.  Med Sci Sports Exerc. 2004;  36 379-387
• 14 Orchard J W. Intrinsic and extrinsic risk factors for muscle strains in Australian football.  Am J Sports Med. 2001;  29 300-303
• 15 Brandser E A, el-Khoury G Y, Kathol M H, Callaghan J J, Tearse D S. Hamstring injuries: radiographic, conventional tomographic, CT, and MR imaging characteristics.  Radiology. 1995;  197 257-262
• 16 Speer K P, Lohnes J, Garrett Jr W E. Radiographic imaging of muscle strain injury.  Am J Sports Med. 1993;  21 89-95 discussion 96
• 17 Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury.  Skeletal Radiol. 2003;  32 582-589
• 18 Blankenbaker D G, De Smet A A. MR imaging of muscle injuries.  Appl Radiol. 2004;  33 14-26
• 19 Zoga A C, Morrison W B. Technical considerations in MR imaging of the hip.  Magn Reson Imaging Clin N Am. 2005;  13 617-634
• 20 De Smet A A, Fisher D R, Heiner J P, Keene J S. Magnetic resonance imaging of muscle tears.  Skeletal Radiol. 1990;  19 283-286
• 21 Slavotinek J P, Verrall G M, Fon G T. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition.  AJR Am J Roentgenol. 2002;  179 1621-1628
• 22 Agre J C. Hamstring injuries. Proposed aetiological factors, prevention, and treatment.  Sports Med. 1985;  2 21-33
• 23 Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study.  Med Sci Sports Exerc. 1983;  15 267-270
• 24 Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload.  Scand J Med Sci Sports. 2003;  13 244-250
• 25 Verrall G M, Slavotinek J P, Barnes G T, Fon G T, Spriggins A J. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging.  Br J Sports Med. 2001;  35 435-440
• 26 Dornan P. A report on 140 hamstring injuries.  Australian J Sports Med. 1971;  4 30-36
• 27 De Smet A A, Best T M. MR imaging of the distribution and location of acute hamstring injuries in athletes.  AJR Am J Roentgenol. 2000;  174 393-399
• 28 Noonan T J, Garrett W E. Injuries at the myotendinous junction.  Clin Sports Med. 1992;  11 783-806
• 29 Fleckenstein J L, Weatherall P T, Parkey R W, Payne J A, Peshock R M. Sports-related muscle injuries: evaluation with MR imaging.  Radiology. 1989;  172 793-798
• 30 Pomeranz S J, Heidt Jr R S. MR imaging in the prognostication of hamstring injury: work in progress.  Radiology. 1993;  189 897-900
• 31 De Smet A A. Magnetic resonance findings in skeletal muscle tears.  Skeletal Radiol. 1993;  22 479-484
• 32 Bush C H. The magnetic resonance imaging of musculoskeletal hemorrhage.  Skeletal Radiol. 2000;  29 1-9
• 33 Nelson E N, Kassarjian A K, Palmer W E. MR imaging of sports-related groin pain.  Magn Reson Imaging Clin N Am. 2005;  13(4) 727-742
• 34 Nurenberg P, Giddings C J, Stray-Gundersen J et al.. MR imaging-guided muscle biopsy for correlation of increased signal intensity with ultrastructural change and delayed-onset muscle soreness after exercise.  Radiology. 1992;  184 865-869
• 35 Shellock F G, Fukunaga T, Mink J H, Edgerton V R. Exertional muscle injury: evaluation with serial MR imaging.  Radiology. 1991;  179 659-664
• 36 May D A, Disler D G, Jones E A, Balkissoon A A, Manaster B J. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls.  Radiographics. 2000;  20(special number) S295-315
• 37 Beiner J M, Jokl P. Muscle contusion injury and myositis ossificans traumatica.  Clin Orthop Relat Res. 2002;  (403 Suppl) S110-S119
• 38 Kransdorf M J, Meis J M, Jelinek J S. Myositis ossificans: MR appearance with radiologic-pathologic correlation.  AJR Am J Roentgenol. 1991;  157 1243-1248
• 39 De Smet A A, Norris M A, Fisher D R. Magnetic resonance imaging of myositis ossificans: analysis of seven cases.  Skeletal Radiol. 1992;  21 503-507
• 40 Tehranzadeh J. The spectrum of avulsion and avulsion-like injuries of the musculoskeletal system.  Radiographics. 1987;  7 945-974
• 41 Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location, and sports distribution of 203 cases collected.  Skeletal Radiol. 2001;  30 127-131
• 42 Stevens M A, El-Khoury G Y, Kathol M H, Brandser E A, Chow S. Imaging features of avulsion injuries.  Radiographics. 1999;  19 655-672
• 43 Paletta Jr G A, Andrish J T. Injuries about the hip and pelvis in the young athlete.  Clin Sports Med. 1995;  14 591-628
• 44 Kujala U M, Orava S. Ischial apophysis injuries in athletes.  Sports Med. 1993;  16 290-294
• 45 Barnes S T, Hinds R B. Pseudotumor of the ischium: a late manifestation of avulsion of the ischial epiphysis.  J Bone Joint Surg Am. 1972;  54 645-647
• 46 Brandser E A, el-Khoury G Y, Kathol M H. Adolescent hamstring avulsions that simulate tumors.  Emerg Radiol. 1995;  2 273-278
• 47 Yamamoto T, Akisue T, Nakatani T et al.. Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging.  Skeletal Radiol. 2004;  33 737-740
• 48 Bui-Mansfield L T, Chew F S, Lenchik L, Kline M J, Boles C A. nontraumatic avulsions of the pelvis.  AJR Am J Roentgenol. 2002;  178 423-427
• 49 Smith P N, Gie G A. Avulsion fracture of the ischium following complex total hip arthroplasty: an unusual cause of hip pain.  J Arthroplasty. 1998;  13 603-606
• 50 Klingele K E, Sallay P I. Surgical repair of complete proximal hamstring tendon rupture.  Am J Sports Med. 2002;  30 742-747
• 51 Cross M J, Vandersluis R, Wood D, Banff M. Surgical repair of chronic complete hamstring tendon rupture in the adult patient.  Am J Sports Med. 1998;  26 785-788
• 52 Sallay P I, Friedman R L, Coogan P G, Garrett W E. Hamstring muscle injuries among water skiers: functional outcome and prevention.  Am J Sports Med. 1996;  24 130-136
• 53 Chakravarthy J, Ramisetty N, Pimpalnerkar A, Mohtadi N. Surgical repair of complete proximal hamstring tendon ruptures in water skiers and bull riders: a report of four cases and review of the literature.  Br J Sports Med. 2005;  39 569-572
• 54 Orava S, Kujala U M. Rupture of the ischial origin of the hamstring muscles.  Am J Sports Med. 1995;  23 702-705
• 55 De Paulis F, Cacchio A, Michelini O, Damiani A, Saggini R. Sports injuries in the pelvis and hip: diagnostic imaging.  Eur J Radiol. 1998;  27(Suppl 1) S49-S59
• 56 Puranen J, Orava S. The hamstring syndrome: a new diagnosis of gluteal sciatic pain.  Am J Sports Med. 1988;  16 517-521
• 57 Kneeland J B. MR imaging of sports injuries of the hip.  Magn Reson Imaging Clin N Am. 1999;  7 105-115 , viii
• 58 Swartout R, Compere E L. Ischiogluteal bursitis: the pain in the arse.  JAMA. 1974;  227 551-552