Proximal hamstring tendinopathy

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Case
An elite male player presented with a three-month history of increasing buttock discomfort. This was initially well localised but then became more generalised with referral into the distal hamstring. The pain was made worse by striding out (sprinting) and with prolonged sitting.

On examination there was a reduced straight leg raise, pain with bridging exercise and localised tenderness about the proximal hamstring and ischial tuberosity. There was a normal hip and lumbar spine examination. A provisional diagnosis of proximal hamstring tendinopathy was made.

Findings
An x-ray image of the hip and pelvis was normal. MRI has demonstrated changes consistent with tendinopathy involving the left proximal hamstring. There is a small amount of intermediate T1 and increased T2 signal on the left. The tendon is slightly thickened compared with the right. There is also a small amount of reactive change in the ischial tuberosity. No tendon tear is present. The proximal hamstring muscles were otherwise normal in signal and are symmetrical in bulk with the right.

Discussion
This player was treated with a progressive strengthening programme. This started with isometric loading but progressed to involve eccentric strengthening (predominantly involving a single leg bridge exercise). As the symptoms were initially quite significant he required a short period (less than three weeks) away from football training. After this he was able to continue playing matches with a reduced training load. It took almost six months for the symptoms to completely resolve.

Proximal hamstring tendinopathy is a relatively uncommon cause of buttock pain. Symptoms are generally worse with prolonged sitting and when striding out (sprinting). The pain can refer into the distal hamstring and can occasionally create weakness and altered sensation due to its proximity to the sciatic nerve. Tenderness about the proximal hamstring, pain with stretching and pain with resisted hamstring contractions are common clinical findings.

As with tendinopathy in other regions, proximal hamstring tendinopathy is generally best treated with a progressive strengthening programme. Other modalities (including shock wave therapy, PRP injections or steroid injections) can have a role in some situations. Very rarely surgical debridement of the tendon is needed.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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PTBodour
23 juillet 2018 23:02

we can use .. shock wave

Greg Mirt
11 juillet 2018 16:13

Schock wave?With tendinopathy can lead to necrosis if terring occurs.

Bangoura
09 juillet 2018 11:18

Dans mes modules antérieurs il y’a eu des erreurs de frappe et des fautes
En place de ORTHESE j ai mis PROTHÈSE dans le module FATIGUE DE STRESS
MOT à la place de MTP(massage transverse
Profond)
Merci pour la compréhension
BANGOURA

Bangoura
07 juillet 2018 16:06

La tendinite principale des ischio jambiers ou tendinite de la fesse est une pathologie bien localisée juste sous le pli fessier CAUSES FAVORISANTES Football gymnastique athletisme(cours se de haie) patinage artistique et les disciplines de vitesse Anatomiquement les ischio jambiers s insserent avec un tendon commun sur la générosité ischiatique Il se compose de 2 couches superficielles: le biceps crural et le semi résineux et profonde le semi menbraneux Les tendinopathies d insertion comme pour les epicondyliens avec lésions de l entorse et parfois microdesinsertion de quelques fibres Les douleurs surviennent par l entraînement et la position assise prolongée sur… Lire la suite »

Greg Mirt
Greg Mirt
11 juillet 2018 16:11

Schock wave?With tendinopathy can lead to necrosis if terring occurs.