INTRODUCTION​

• Proximal hamstring tears or ruptures are uncommon injuries

• The proximal hamstring consists of three tendons: semimembranosus, semitendinosus, and biceps femoris (long head)

• These tendons insert on the ischial tuberosity in the back of the pelvis

• Injuries can occur in the musculotendinous junction (most common), tendon avulsion off the bone, or bony avulsions (more common in adolescents)

• The sciatic nerve is very close to the proximal hamstring and injuries can be associated with numbness and tingling

• CAUSES

• Proximal hamstring ruptures usually occur during running when the hip is flexed (bent) and the knee is extended (straightened out)

• It usually occurs during sprinting or with rapid acceleration

• SIGNS AND SYMPTOMS

• Patients with proximal hamstring ruptures have posterior buttock pain 

• They often report hearing a sharp pain and a pop

• Difficulty walking may result

• Swelling and bruising is common in the posterior thigh area

• TREATMENT​​

• A course of rest, ice, anti-inflammatories, protected weight bearing with crutches, stretching, and a home exercise program is the mainstay of treatment for proximal hamstring ruptures. More than 90% of proximal hamstring injuries are treated with this program

• Orthobiologics such as platelet rich plasma (PRP) can be considered for proximal hamstring ruptures and emerging evidence suggests an earlier return to sport with PRP in proximal hamstring injuries.. The theory behind this is that PRP can deliver growth factors to the degenerative rotator cuff tendons which have poor blood supply and healing potential. This may result in healing and decreased pain

• Surgery is considered in patients with multiple (2 or more) tendon ruptures, greater than 2cm of retraction of tendon, failure of extensive conservative management

        PREVENTION

• Strengthening and stretching the hamstrings and warming up prior to physical activity can help decrease the chance of a proximal hamstring injury