Thigh sports injuries

Question 1

Where do hamstring injuries occur?

what is the mechanism of injury?

Answer 1

• Musculotendinous junction
  
  • most common site
  • often occurs in sprinting
• Avulsion of ischial tuberosity
  
  • less common
  • skeletally immature

Mechanism

• Occurs as result of Hip flexion and knee extension

Question 2

name the hamstring muscles and what are their common characteristics?

Answer 2

• Semimembranosus
• Semitendinousis
• Biceps femoris
  
  • Long head
  • Short head

Characteristics

• originate at ischial tuberosity
• inervated by sciatic ( tibial ) nerve
• blood supply from inferior gluteal artery and profunda femoral artery
• cross and act upon 2 joints: the hip /knee ( except biceps femoris)

Question 3

Describe the anatomy of semimembranosus?

Answer 3

• Origin : superior lateral quadrant of ischial tuberosity
• insertion: posterior surface of medial tibial condyle
• action: extends the thigh, flexes the knee and rotates the tibia medially esp when knee flexed
• inervation: Tibial nerve L5,S1, s2
• blood supply: perforating branches of profunda femoris arrtery, inf gluteal artery, and superior muscular branches of popliteal artery

Question 4

Describe the anatomy of semitendinosus?

Answer 4

• origin: common tendon with long head of biceps femoris from superior medial quadrant of post portion of ischial tuberosity
• Insertion: Superior aspect of medial portion ot tibial shaft
• action: extends thigh and flexes knee, also rotates tibia medially , esp when knee is flexed
• innervation: Tibial nerve L5,S1/S2
• Arterial supply: perforating branches of profunda femoris artery , inf gluteal artery, superior muscular branches of popliteal artery

Question 5

Describe the anatomy of long head of biceps femoris?

Answer 5

• Common tendon with Semitendinosus from superior medial quadrant of the posterior portion of the ischial tuberosity
• insertion: primarily onto fibular head + lateral collateral lig adn lateral tibial condyle
• action: flexes knee , rotates tibia laterally , also extends hip joint
• innervation : Tibial nerve L5, S1, S2
• Arterial supply: Peforating branches of profunda femoris artery, inferior gluteal artery, superior muscular branches of popliteal artery

Question 6

Describe the anatomy of short head of biceps femoris?

Answer 6

• origin: lateral tip of linea aspera, lateral suprcondylar ridge of femur and lateral intermuscular septum
• Insertion: primarly on fibular head, also lateral collateral ligament and lateral tibial condyle
• action: flexes knee, rotates tibia laterally , long head extends hip
• Innervation: common peroneal n - L5, S1,S2
• Arterial supply: perforating branches of profunda femoris artery, inf gluteal artery, and superior muscular branches of popliteal artery

Question 7

What is seen on presentation and xrays of hamstring injuries?

Answer 7

• Presentation
  
  • ecchymosis in post thigh
  • palpable mass in midle 1/3 rd of post thigh - myotendinous
  • normal hamstring/quads ratio is 65%
• Xray
  
  • avusino off ischial tuberosity

Question 8

What is the tx for hamstring injuries?

Answer 8

Non operative

• protected WB for 4 weeks, then stretching and strengthening
  
  • most hamstring injuries
  • rupture at myotendinous junction
  • return to play when strength is 90% of contralateral side

Operative

• Operative repair
  
  • proximal avulsion ruptures
  • transverse incision at gluteal crease
  • protecton of sciatic n
  • mobilisation of rupture tendons
  • repair of ischial tuberosity with suture anchors