Download PDF
Semin Musculoskelet Radiol 2017; 21(04): 415-432
DOI: 10.1055/s-0037-1604005
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of Acute Hamstring Muscle Strain Injuries

Simon Dimmick
1   Castlereagh Imaging, Westmead, Australia
,
James M. Linklater
1   Castlereagh Imaging, Westmead, Australia
2   University of Sydney, Northern Clinical School, Royal North Shore Hospital, New South Wales, Australia
3   University of New South Wales, Faculty of Medicine, Kensington, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
03 August 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Acute athletic hamstring muscle strain injuries are common and a cause of significant time off sport. An understanding of the anatomy of the hamstring muscle-tendon units is a prerequisite for interpreting the spectrum of structural abnormalities on imaging. The site of injury may range from proximal tendon, proximal myotendinous junction, with or without tendon injury, muscle, myofascial junction, distal myotendinous junction to distal tendon. Imaging findings in muscle injury range from intrafascicular and interfascicular muscle edema, blurring of fascicular margins, distortion of pennation angle, localized muscle fascicle discontinuity through to more extensive multi-fascicular discontinuity. Imaging findings in tendon injury include tendon edema, redundancy, zipper-like morphology, and partial-complete tendon discontinuity. Imaging findings in fascial injury include poor definition of fascial margins with perifascial edema through to a fascial defect. Published grading systems are presented, and their so far limited utility in predicting return to play is reviewed.

Keywords

hamstring - muscle injury - strain - MRI - ultrasound
 

  • References

  • 1 Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med 2007; 35 (02) 197-206
    CrossrefPubMedGoogle Scholar
  • 2 Elliott MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football players: a 10-year review. Am J Sports Med 2011; 39 (04) 843-850
    CrossrefPubMedGoogle Scholar
  • 3 Devlin L. Recurrent posterior thigh symptoms detrimental to performance in rugby union: predisposing factors. Sports Med 2000; 29 (04) 273-287
    CrossrefPubMedGoogle Scholar
  • 4 Drezner JA. Practical management: hamstring muscle injuries. Clin J Sport Med 2003; 13 (01) 48-52
    CrossrefPubMedGoogle Scholar
  • 5 Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A. ; Football Association Medical Research Programme. The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries. Br J Sports Med 2004; 38 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 6 Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39 (06) 1226-1232
    CrossrefPubMedGoogle Scholar
  • 7 Verrall GM, Kalairajah Y, Slavotinek JP, Spriggins AJ. Assessment of player performance following return to sport after hamstring muscle strain injury. J Sci Med Sport 2006; 9 (1-2): 87-90
    CrossrefPubMedGoogle Scholar
  • 8 Seward H, Orchard J, Hazard H, Collinson D. Football injuries in Australia at the élite level. Med J Aust 1993; 159 (05) 298-301
    CrossrefPubMedGoogle Scholar
  • 9 Brooks JH, Fuller CW, Kemp SP, Reddin DB. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med 2006; 34 (08) 1297-1306
    CrossrefPubMedGoogle Scholar
  • 10 Heiser TM, Weber J, Sullivan G, Clare P, Jacobs RR. Prophylaxis and management of hamstring muscle injuries in intercollegiate football players. Am J Sports Med 1984; 12 (05) 368-370
    CrossrefPubMedGoogle Scholar
  • 11 Orchard J, James T, Alcott E, Carter S, Farhart P. Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36 (04) 270-274 ; discussion 275
    CrossrefPubMedGoogle Scholar
  • 12 Croisier JL. Factors associated with recurrent hamstring injuries. Sports Med 2004; 34 (10) 681-695
    CrossrefPubMedGoogle Scholar
  • 13 Mueller-Wohlfahrt HW, Haensel L, Mithoefer K. , et al. Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 2013; 47 (06) 342-350
    CrossrefPubMedGoogle Scholar
  • 14 Thelen DG, Chumanov ES, Hoerth DM. , et al. Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc 2005; 37 (01) 108-114
    CrossrefPubMedGoogle Scholar
  • 15 Garrett Jr WE, Safran MR, Seaber AV, Glisson RR, Ribbeck BM. Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 1987; 15 (05) 448-454
    CrossrefPubMedGoogle Scholar
  • 16 Rehorn MR, Blemker SS. The effects of aponeurosis geometry on strain injury susceptibility explored with a 3D muscle model. J Biomech 2010; 43 (13) 2574-2581
    CrossrefPubMedGoogle Scholar
  • 17 Kumazaki T, Ehara Y, Sakai T. Anatomy and physiology of hamstring injury. Int J Sports Med 2012; 33 (12) 950-954
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Butterfield TA. Eccentric exercise in vivo: strain-induced muscle damage and adaptation in a stable system. Exerc Sport Sci Rev 2010; 38 (02) 51-60
    CrossrefPubMedGoogle Scholar
  • 19 Lieber RL, Fridén J. Selective damage of fast glycolytic muscle fibres with eccentric contraction of the rabbit tibialis anterior. Acta Physiol Scand 1988; 133 (04) 587-588
    CrossrefPubMedGoogle Scholar
  • 20 Anthony DC, Frosch MP, De Girolami U. Peripheral nerve and skeletal muscle. In: Kumar V, Abbas A, Fausto N. , eds. Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia, PA: Elsevier Saunders; 2005: 1327-1328
    Google Scholar
  • 21 Kijowski R. Magnetic resonance imaging of muscle injury. In: International Society for Magnetic Resonance in Medicine Conference Proceedings. 2011
    PubMedGoogle Scholar
  • 22 Morgan DL. New insights into the behavior of muscle during active lengthening. Biophys J 1990; 57 (02) 209-221
    CrossrefPubMedGoogle Scholar
  • 23 Brockett CL, Morgan DL, Proske U. Predicting hamstring strain injury in elite athletes. Med Sci Sports Exerc 2004; 36 (03) 379-387
    CrossrefPubMedGoogle Scholar
  • 24 Novacheck TF. The biomechanics of running. Gait Posture 1998; 7 (01) 77-95
    CrossrefPubMedGoogle Scholar
  • 25 Orchard J, Walt S, McIntosh A, Garlick D. Muscle activation during the drop punt kick. J Sports Sci 1999; 17 (10) 837-838
    PubMedGoogle Scholar
  • 26 Schache AG, Dorn TW, Blanch PD, Brown NAT, Pandy MG. Mechanics of the human hamstring muscles during sprinting. Med Sci Sports Exerc 2012; 44 (04) 647-658
    CrossrefPubMedGoogle Scholar
  • 27 Schache AG, Blanch PD, Dorn TW, Brown NAT, Rosemond D, Pandy MG. Effect of running speed on lower limb joint kinetics. Med Sci Sports Exerc 2011; 43 (07) 1260-1271
    CrossrefPubMedGoogle Scholar
  • 28 Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Br J Sports Med 2013; 47 (06) 351-358
    CrossrefPubMedGoogle Scholar
  • 29 Hallén A, Ekstrand J. Return to play following muscle injuries in professional footballers. J Sports Sci 2014; 32 (13) 1229-1236
    CrossrefPubMedGoogle Scholar
  • 30 Crema MD, Guermazi A, Tol JL, Niu J, Hamilton B, Roemer FW. Acute hamstring injury in football players: association between anatomical location and extent of injury—a large single-center MRI report. J Sci Med Sport 2016; 19 (04) 317-322
    CrossrefPubMedGoogle Scholar
  • 31 Nikolaou PK, Macdonald BL, Glisson RR, Seaber AV, Garrett Jr WE. Biomechanical and histological evaluation of muscle after controlled strain injury. Am J Sports Med 1987; 15 (01) 9-14
    CrossrefPubMedGoogle Scholar
  • 32 Taylor DC, Dalton Jr JD, Seaber AV, Garrett Jr WE. Experimental muscle strain injury. Early functional and structural deficits and the increased risk for reinjury. Am J Sports Med 1993; 21 (02) 190-194
    CrossrefPubMedGoogle Scholar
  • 33 Garrett Jr WE, Nikolaou PK, Ribbeck BM, Glisson RR, Seaber AV. The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension. Am J Sports Med 1988; 16 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 34 Bloch W. Muscle healing: physiology and adverse factors. In: Mueller-Wolfhaht HW, Ueblacker P, Haensel L, Garrett WE. , eds. Muscle Injury in Sports. New York, NY: Thieme Medical; 2013
    Google Scholar
  • 35 Andersen TE, Tenga A, Engebretsen L, Bahr R. Video analysis of injuries and incidents in Norwegian professional football. Br J Sports Med 2004; 38 (05) 626-631
    CrossrefPubMedGoogle Scholar
  • 36 Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg 1998; 6 (04) 237-248
    CrossrefPubMedGoogle Scholar
  • 37 Warren P, Gabbe BJ, Schneider-Kolsky M, Bennell KL. Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. Br J Sports Med 2010; 44 (06) 415-419
    CrossrefPubMedGoogle Scholar
  • 38 O'Donoghue DO. Treatment of Injuries to Athletes. Philadelphia, PA: WB Saunders; 1962
    Google Scholar
  • 39 Connell DA, Schneider-Kolsky ME, Hoving JL. , et al. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 2004; 183 (04) 975-984
    CrossrefPubMedGoogle Scholar
  • 40 Woodhouse JB, McNally EG. Ultrasound of skeletal muscle injury: an update. Semin Ultrasound CT MR 2011; 32 (02) 91-100
    CrossrefPubMedGoogle Scholar
  • 41 Peetrons P. Ultrasound of muscles. Eur Radiol 2002; 12 (01) 35-43
    CrossrefPubMedGoogle Scholar
  • 42 Hansel L, Ueblacker P, Betthause A. Ultrasonography muscle injury. In: Mueller-Wolfahrt HW, Ueblacker P, Haensel L, Garrett WE. , eds. Muscle Injury in Sports. New York, NY: Thieme Medical; 2010
    Google Scholar
  • 43 Peetrons P, Creteur P. Echographies et traumatismes musculaires aigus. In: Chevrot A, Kahn M, Morvan G. , eds. Imagerie des Parties Molles de l'Appareil Locomoteur. Paris, France: Sauramps Medical; 1993: 229-235
    Google Scholar
  • 44 Kerkhoffs GM, van Es N, Wieldraaijer T, Sierevelt IN, Ekstrand J, van Dijk CN. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 500-509
    CrossrefPubMedGoogle Scholar
  • 45 Ekstrand J, Lee JC, Healy JC. MRI findings and return to play in football: a prospective analysis of 255 hamstring injuries in the UEFA Elite Club Injury Study. Br J Sports Med 2016; 50 (12) 738-743
    CrossrefPubMedGoogle Scholar
  • 46 Speer KP, Lohnes J, Garrett Jr WE. Radiographic imaging of muscle strain injury. Am J Sports Med 1993; 21 (01) 89-95 , discussion 96
    CrossrefPubMedGoogle Scholar
  • 47 Wangensteen A, Almusa E, Boukarroum S. , et al. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med 2015; 49 (24) 1579-1587
    CrossrefPubMedGoogle Scholar
  • 48 Valle X, Alentorn-Geli E, Tol JL. , et al. Muscle injuries in sports: a new evidence-informed and expert consensus-based classification with clinical application. Sports Med 2016
    PubMedGoogle Scholar
  • 49 Gillies AR, Lieber RL. Structure and function of the skeletal muscle extracellular matrix. Muscle Nerve 2011; 44 (03) 318-331
    PubMedGoogle Scholar
  • 50 Bock J, Mundinger P, Luttke G. MRI Muscle Injury. In: Mueller-Wolfahrt HW, Ueblacker P, Haensel L, Garrett WE. , eds. Muscle Injury in Sports. New York, NY: Thieme Medical; 2013
    Google Scholar
  • 51 Comin J, Malliaras P, Baquie P, Barbour T, Connell D. Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med 2013; 41 (01) 111-115
    CrossrefPubMedGoogle Scholar
  • 52 Brukner P, Connell D. ‘Serious thigh muscle strains’: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. Br J Sports Med 2016; 50 (04) 205-208
    CrossrefPubMedGoogle Scholar
  • 53 Shellock FG, Fukunaga T, Mink JH, Edgerton VR. Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging. Radiology 1991; 179 (03) 659-664
    CrossrefPubMedGoogle Scholar
  • 54 Adams GR, Duvoisin MR, Dudley GA. Magnetic resonance imaging and electromyography as indexes of muscle function. J Appl Physiol (1985) 1992; 73 (04) 1578-1583
    CrossrefPubMedGoogle Scholar
  • 55 Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 1984; 16 (06) 529-538
    PubMedGoogle Scholar
  • 56 Evans WJ, Cannon JG. The metabolic effects of exercise-induced muscle damage. In: Holloszy JO. , ed. Exercise and Sport Sciences Reviews. Baltimore, MD: Williams & Wilkins; 1991: 99
    Google Scholar
  • 57 Abraham WM. Factors in delayed muscle soreness. Med Sci Sports 1977; 9 (01) 11-20
    PubMedGoogle Scholar
  • 58 Fleckenstein JL, Weatherall PT, Bertocci LA. , et al. Locomotor system assessment by muscle magnetic resonance imaging. Magn Reson Q 1991; 7 (02) 79-103
    PubMedGoogle Scholar
  • 59 McCully K, Shellock FG, Bank WJ, Posner JD. The use of nuclear magnetic resonance to evaluate muscle injury. Med Sci Sports Exerc 1992; 24 (05) 537-542
    PubMedGoogle Scholar
  • 60 Takahashi H, Kuno S, Miyamoto T. , et al. Changes in magnetic resonance images in human skeletal muscle after eccentric exercise. Eur J Appl Physiol Occup Physiol 1994; 69 (05) 408-413
    CrossrefPubMedGoogle Scholar
  • 61 Cleak MJ, Eston RG. Delayed onset muscle soreness: mechanisms and management. J Sports Sci 1992; 10 (04) 325-341
    CrossrefPubMedGoogle Scholar
  • 62 Nurenberg P, Giddings CJ, Stray-Gundersen J, Fleckenstein JL, Gonyea WJ, Peshock RM. MR imaging-guided muscle biopsy for correlation of increased signal intensity with ultrastructural change and delayed-onset muscle soreness after exercise. Radiology 1992; 184 (03) 865-869
    CrossrefPubMedGoogle Scholar
  • 63 Fleckenstein JL, Weatherall PT, Parkey RW, Payne JA, Peshock RM. Sports-related muscle injuries: evaluation with MR imaging. Radiology 1989; 172 (03) 793-798
    CrossrefPubMedGoogle Scholar
  • 64 Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. Am J Sports Med 2005; 33 (05) 745-764
    CrossrefPubMedGoogle Scholar
  • 65 Beiner JM, Jokl P. Muscle contusion injury and myositis ossificans traumatica. Clin Orthop Relat Res 2002; ;(403, Suppl) S110-S119
    PubMedGoogle Scholar
  • 66 Hamilton B, Valle X, Rodas G. , et al. Classification and grading of muscle injuries: a narrative review. Br J Sports Med 2015; 49 (05) 306
    CrossrefPubMedGoogle Scholar
  • 67 Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics 2005; 25 (03) 571-586
    CrossrefPubMedGoogle Scholar
  • 68 Ekstrand J, Healy JC, Waldén M, Lee JC, English B, Hägglund M. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med 2012; 46 (02) 112-117
    CrossrefPubMedGoogle Scholar
  • 69 Cross TM, Gibbs N, Houang MT, Cameron M. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med 2004; 32 (03) 710-719
    CrossrefPubMedGoogle Scholar
  • 70 Gibbs NJ, Cross TM, Cameron M, Houang MT. The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. J Sci Med Sport 2004; 7 (02) 248-258
    CrossrefPubMedGoogle Scholar
  • 71 Slavotinek JP. Muscle injury: the role of imaging in prognostic assignment and monitoring of muscle repair. Semin Musculoskelet Radiol 2010; 14 (02) 194-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Pollock N, James SL, Lee JC, Chakraverty R. British athletics muscle injury classification: a new grading system. Br J Sports Med 2014; 48 (18) 1347-1351
    CrossrefPubMedGoogle Scholar
  • 73 Patel A, Chakraverty J, Pollock N, Chakraverty R, Suokas AK, James SL. British athletics muscle injury classification: a reliability study for a new grading system. Clin Radiol 2015; 70 (12) 1414-1420
    CrossrefPubMedGoogle Scholar
  • 74 Moen MH, Reurink G, Weir A, Tol JL, Maas M, Goudswaard GJ. Predicting return to play after hamstring injuries. Br J Sports Med 2014; 48 (18) 1358-1363
    CrossrefPubMedGoogle Scholar
  • 75 Orchard J. What role for MRI in hamstring strains? An argument for a difference between recreational and professional athletes. Br J Sports Med 2014; 48 (18) 1337-1338
    CrossrefPubMedGoogle Scholar
  • 76 Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sport Med 2005; 15 (06) 436-441
    CrossrefPubMedGoogle Scholar
  • 77 Orchard J. More research is needed into the effects on injury of substitute and interchange rules in team sports. Br J Sports Med 2012; 46 (10) 694-695
    CrossrefPubMedGoogle Scholar