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Aug 31st
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MRI - Hamstring

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Both MRI and ultrasound are highly accurate in demonstrating injuries of the hamstring muscles [1,2.]

The hamstrings are composed of several muscles, with the most frequently injured muscle being the long head of biceps femoris [3.]

In professional athletes, MRI and ultrasound may be used to assist in estimating the time out of competition, and allowing athletes to return to competition safely [4.]

Hamstring tears usually heal well with time, strengthening and a rehabilitation programme, however in certain settings, such as a non healing tear, degeneration of the tendon or overlying bursitis, non specific pain, such as sciatica like symptoms, as well as buttock pain, may occur.  In this setting, further ultrasound guided treatment may be of benefit [5.] This often results in non specific pain, such as sciatica like symptoms as well as buttock pain, exacerbated when sitting down.

Treatment options include autologous blood/platelet rich plasma injections as well as cortisone injections into the ischial bursa, which overlies the hamstring tendons. Inflammation and scar tissue surrounding the hamstring muscles may entrap the adjacent sciatic nerve and may result in poor hamstring stretch and sciatica. In these patients, ultrasound guided sciatic nerve release/neurolysis is often therapeutic.

References
  1. Connell DA, Schneider-Kolsky ME, Hoving JL, Malara F, Buchbinder R, Koulouris G, Burke F, Bass C. Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 183(4):975-84, 2004
  2. Koulouris G, Connell D. Hamstring muscle complex: an imaging review. Radiographics 25(3):571-86, 2005
  3. Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 32(10):582-9, 2003
  4. Koulouris G, Connell DA, Brukner P, Schneider-Kolsky M. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 35(9):1500-6, 2007
  5. Koulouris G, Connell D. Imaging of hamstring injuries: therapeutic implications. Eur Radiol 16(7):1478-87, 2006

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