Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete: a case report

updated Jan 10, 2016

Tags: strain, case, diagnosis, injury, pain problems, muscle

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Complete hamstring avulsions — that is, complete ruptures of muscles where they attach to bones — are not necessarily obvious. They aren’t all as painful initially as they sound. And according to this study, they “can be difficult to diagnose acutely due to swelling and patient guarding, which may mask a visibly palpable defect and lead to delays in diagnosis.” Yikes!

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND AND PURPOSE: Hamstring injuries are frequent injuries in athletes, with the most common being strains at the musculotendinous junction or within the muscle belly. Conversely, hamstring avulsions are rare and often misdiagnosed leading to delay in appropriate surgical interventions. The purpose of this case report is to describe the history and physical examination findings that led to appropriate diagnostic imaging and the subsequent diagnosis and expedited surgical intervention of a complete avulsion of the hamstring muscle group from the ischium in a military combatives athlete.

CASE DESCRIPTION: The patient was a 25 year-old male who sustained a hyperflexion injury to his right hip with knee extension while participating in military combatives, presenting with acute posterior thigh and buttock pain. History and physical examination findings from a physical therapy evaluation prompted an urgent magnetic resonance imaging (MRI) study, which led to the diagnosis of a complete avulsion of the hamstring muscle group off the ischium.

OUTCOME: Expedited surgical intervention occurred within 13 days of the injury potentially limiting comorbidities associated with delayed diagnosis.

CONCLUSION: Recognition of the avulsion led to prompt surgical evaluation and intervention. Literature has shown that diagnosis of hamstring avulsions are frequently missed or delayed, which results in a myriad of complications.

LEVEL OF EVIDENCE: Level 4.

original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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