![]() A possible pop and/or delayed appearance of ecchymosis around the area of pain presents in more extreme cases. Ĭlinically, patients typically describe hamstring muscle strains as beginning acutely during physical activities involving the lower body with a sharp or stabbing pain in the proximal posterior thigh with increasing pain with active extension of the hip or flexion of the knee. Of these two types of injuries, type 2 has been shown to require more time to fully heal and return to sports compared to type 1. These types of injuries most commonly occur during actions involving flexion of the hip with an extension of the knee. Type 2 hamstring strains result from extensive muscle lengthening, resulting in overstretching and injury to the proximal tendon area of the semimembranosus muscle. Type 1, involving mainly the proximal tendon muscle junction of the biceps femoris, results during the terminal deceleration of the swing phase of running as the patient prepares to plant their foot resulting in eccentric muscle contraction. Two types of acute hamstring strains appear in the current literature. Patients largely report strains due to quick changes in speed and excessive lengthening of the hamstrings due to a particular inciting event or experiencing proximal tendinopathy resulting from excessive use over long periods. Hamstring muscle injuries are currently one of the most common injuries suffered by athletes. Removal of the semitendinosus and sometimes gracilus tendons from their insertion site into the pes anserinus for use in ACL repairs has been shown to have advantages over other autograft methods (such as using the patellar tendon) with less post-operative knee pain and an overall easier recovery following surgery. Other surgical considerations regarding the hamstring muscles include autografting hamstring tendons to reconstruct the ACL in patients with tears. The decision to indicate a patient for surgery depends on the distance that the tendon has retracted and the chronicity of symptoms. ![]() Surgical procedures have been shown to have better results when used in treating more severe avulsion injuries, as well as being performed on more acute injuries compared to chronic avulsion injuries. Patients with avulsion injuries of the proximal hamstring muscles from their origin may benefit from surgical treatment of their injuries regarding pain levels and functional outcomes, particularly if they are young and active. Patients may present with ecchymosis over the posterior thigh and a stiff-legged gait to avoid flexion at the hip and knee. ![]() Surgical treatments involving the hamstring muscles are rare, as conservative treatment for injuries is the preferred first-line management. The hamstrings additionally provide minor rotation pull on the lower extremity based on their lateral or medial insertion points distally (biceps femoris provides external rotation, semitendinosus/semimembranosus provides internal rotation). The ability to remain stable while standing is also largely attributed to the actions of the hamstring muscles, which allow the body to remain erect above the lower extremities by securely fixing the hip joint. These actions are significant components of the multi-joint movements of standing up from a seated position and normal gait. The superior-lateral border of the popliteal fossa is created by the biceps femoris, while the superior medial border forms from the semimembranosus and semitendinosus.Īs a group of muscles, the hamstring muscles primarily work to extend the hip (movement of the femur directly posteriorly) and flex the knee (movement of the tibia and fibula directly posteriorly). The superior or proximal borders of the popliteal fossa, posterior to the knee, are created by the hamstring muscles descending and crossing the joint. The short head of the biceps femoris originates independently from the lateral linea aspera of the posterior femur before joining with the long head of the biceps femoris to span the knee. The long head of the biceps femoris, semitendinosus, and semimembranosus originate from the ischial tuberosity of the pelvis extending distally on the posterior side of the femur, eventually crossing the knee - the biceps femoris crossing laterally while semimembranosus and semitendinosus cross medially. Except for the short head of the biceps femoris, the other posterior thigh muscles span the length of the femur and coss, both the hip and knee joints. Spanning from the posterior pelvis to the proximal tibia and fibula, the posterior thigh muscles provide motion to both the femoroacetabular joint (hip joint) and tibiofemoral joint (knee joint).
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