Potential hamstring injury blind spot: we need to raise awareness of proximal hamstring tendon avulsion injuries

[...]we hypothesised that there is a hamstring injury blind spot, meaning that this injury may be heavily underdiagnosed due to poor awareness. The consequences Missing a proximal hamstring tendon avulsion could have serious consequences, as poor clinical outcome has been reported if it is left untr...

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Bibliographic Details
Published in:British journal of sports medicine 2019-04, Vol.53 (7), p.390-392
Main Authors: van der Made, Anne D, Tol, Johannes L, Reurink, Gustaaf, Peters, Rolf W, Kerkhoffs, Gino M
Format: Article
Language:English
Subjects:
Contusions
Knee
Medical diagnosis
Pain
Patients
Physicians
Professional football
Professionals
Sports injuries
Systematic review
Trauma
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Summary:[...]we hypothesised that there is a hamstring injury blind spot, meaning that this injury may be heavily underdiagnosed due to poor awareness. The consequences Missing a proximal hamstring tendon avulsion could have serious consequences, as poor clinical outcome has been reported if it is left untreated.6 The current body of evidence, despite its limitations, indicates that surgical intervention yields better subjective and functional outcomes than a non-operative approach and thus surgical consultation should be considered. [...]a delayed diagnosis can also affect chances of a good outcome, since delayed intervention (ie, later than 47 or 88 weeks after injury) is reported to result in inferior outcome, and is considered to be more difficult for the surgeon.2 In addition, even if the patient and the doctor were to make a shared decision in favour of conservative treatment, an adequate conservative treatment protocol would be expected to produce favourable results compared with a missed diagnosis.8 Clinical picture and pitfalls The potential consequences of a missed or delayed diagnosis underline the need for a high level of suspicion of proximal hamstring tendon avulsion when certain clinical clues are present (box 1). If clinical evaluation is suggestive of a proximal tendon avulsion or leaves room for any doubt, imaging by means of ultrasound or MRI should be performed to confirm or rule out tendon avulsion injury.Box 1 Key clinical features Typical clinical findings in proximal hamstring tendon avulsion injury Trauma mechanism involves forced hip flexion combined with knee extension.
ISSN:0306-3674
1473-0480
DOI:10.1136/bjsports-2018-100063