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Sportverletz Sportschaden 2024; 38(01): 31-39
DOI: 10.1055/a-2010-8121
Review

Pathogenesis and Diagnosis of Proximal Hamstring Tendinopathies

Pathogenese und Diagnostik von proximalen Hamstring-Tendinopathien
Sarah Schroeter
1   Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany (Ringgold ID: RIN9186)
,
Rafael Heiss
2   Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN27168)
3   Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany (Ringgold ID: RIN9186)
,
Christian Manfred Hammer
4   Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN9171)
5   Anatomy Unit, Section of Medicine, University of Fribourg, Fribourg, Switzerland
,
Raymond Best
3   Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany (Ringgold ID: RIN9186)
6   Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
7   Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Stuttgart, Germany (Ringgold ID: RIN88941)
,
Peter Brucker
8   ATOS Klinik München, München, Germany
,
Stefan Hinterwimmer
9   OrthoPlus Munich, München, Germany
,
Casper Grim
1   Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany (Ringgold ID: RIN9186)
10   Department of Human Sciences Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
,
Martin Engelhardt
1   Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany (Ringgold ID: RIN9186)
,
Thilo Hotfiel
1   Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany (Ringgold ID: RIN9186)
3   Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany (Ringgold ID: RIN9186)
11   Department of Orthopedic and Trauma Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN9171)
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Abstract

The proximal hamstring complex is a highly vulnerable area that is especially prone to injury. Proximal hamstring tendinopathies (PHTs) remain challenging in diagnosis, treatment, rehabilitation, and prevention due to a large variety of different injuries, slow healing response, persistent symptoms, and functional impairments. PHTs are often misdiagnosed or underdiagnosed, leading to delayed treatment and therapy failure. In addition, many athletes are at a high risk of PHT recurrence, a leading cause of prolonged rehabilitation and impaired individual performance. Until now, there have been no clear criteria for the diagnosis and classification of PHT. Tendinopathies can be graded based on their symptoms and onset. Additionally, radiological characteristics exist that describe the severity of tendinopathies. The diagnosis usually includes a battery of pain provocation tests, functional tests, and imaging to ensure a proper classification. Understanding the specific tasks in the pathogenesis and diagnostic process of PHT requires knowledge of functional anatomy, injury pattern and pathophysiological mechanisms as well as examination and imaging techniques. This work provides a structured overview of the pathogenesis and diagnostic work-up of PHT, emphasizing structured examination and imaging to enable a reliable diagnosis and rapid treatment decisions.

Zusammenfassung

Die proximale Hamstring-Muskulatur ist ein hochgradig vulnerabler Bereich, der besonders verletzungsanfällig ist. Proximale Hamstring-Tendinopathien (PHT) stellen aufgrund der heterogenen Verletzungsmorphologien, des langsamen Heilungsverlaufs, der diffusen, jedoch erheblichen Symptome und der funktionellen Beeinträchtigungen eine Herausforderung für die Diagnostik, Therapie, Rehabilitation und Prävention dar. PHT werden häufig inadäquat, verspätet oder überhaupt nicht diagnostiziert, was zu einer verzögerten Behandlung und hohen Rate an Therapieversagen führt. Darüber hinaus besteht bei vielen Sportlern ein hohes Rezidivrisiko, welches eine der Hauptursachen für einen langwierigen Heilungsverlauf darstellt. Bislang gibt es keine klaren Kriterien für die Diagnose und Klassifizierung von PHT. Tendinopathien können anhand ihrer Symptome und ihres Auftretens eingeteilt werden. Außerdem gibt es radiologische Merkmale, die den Schweregrad von Tendinopathien beschreiben. Die Diagnose umfasst in der Regel eine Reihe von Schmerzprovokationstests, Funktionstests und bildgebenden Verfahren. Um die spezifischen Aspekte in der Pathogenese und im diagnostischen Prozess der PHT zu verstehen, sind Kenntnisse der funktionellen Anatomie, der Verletzung und der pathophysiologischen Mechanismen sowie der Untersuchungs- und Bildgebungstechniken erforderlich. Die vorliegende Arbeit liefert einen strukturierten Überblick über die Pathogenese und den diagnostischen Ablauf, wobei der Schwerpunkt auf einer strukturierten Untersuchung und Bildgebung liegt, um eine zuverlässige Diagnose und schnelle Behandlungsentscheidungen zu ermöglichen.

Keywords

Hamstring anatomy - tendinopathies - muscle injuries - sports injuries - overuse injuries - ultrasound - MRI

Schlüsselwörter

Anatomie der Hamstrings - Tendinopathien - Muskelverletzungen - Sportverletzungen - Überlastungsverletzungen - Sonografie - MRT


Publication History

Received: 07 April 2022

Accepted after revision: 09 January 2023

Article published online:
22 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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