Hamstring tear (Full Version)

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Jeff Weil -> Hamstring tear (April 23, 2000 6:09:00 AM)

Looking for folks thoughts on this patient. Playing basketball this guy tears a hamstring. Appears to be lateral and appears to be biceps femoris, long head. Has severe bruising from mid posterior thigh to mid calf. Difficulty sitting due to pain at the ischial tuberosity. Swelling is reduced yesterday enough to be able to appreciate the thigh contours. With active standing knee flexion he gets a very large buldge at the hamstrings, laterally. Pain is moderate and he cannot accept resistance to the motion, due to pain. The tendon appears to be intact at the fibula but I am wondering about this large buldge. What would give you a thought that maybe this is more than just a strain, as the MD diagnosis reads and instead is a rupture or tear?



Randy Moore -> Re: Hamstring tear (April 24, 2000 3:58:00 AM)

Two responses sent directly to RehabEdge:

1. in regards to the possibility of the hamstring rupture, I have no doubt,
that this is a partial rupture, as I have seen a similar scenario in the
biceps tear, or partial tear. I beleive that pain is not all that
important, it is rather the lack of function and the rolled up torn muscle
observed.

In regards to treatment, I suspect that a MRI might demonstrate the size of
the tear and upon this information, the surgeon may decide to go in and
repair. Otherwise, I suspect that skillful neglect and time will resolve
this problem.

2. Sounds like a tear. Do a MMT and have the MD get a MRI for the pt. You can't
palpate at hamstring origin very easily if at all.So it probably be best to
get the MRI. But that is just my opinion?



mcap -> Re: Hamstring tear (April 24, 2000 7:13:00 AM)

Jeff:

I would have to agree with the previous post. Definitely sounds like a tear. Whether to repair the muscle or not is a tricky question but it is one to be addressed by the orthopedist. An MRI would be in order.

I have never seen one torn so badly but I know that in the Pec Tear cases I have seen, there is a window in which the patients need to have the surgery.

I have heard (but I don't know about research support) that rotating the ankle laterally with the knee flexed t0 90 and then performing a knee flexion MMT will reflect more on the Biceps Femoris than the Semimem and Semitend. Call the Dr. with your results.

-mcap



CharlieK -> Re: Hamstring tear (April 25, 2000 1:34:00 AM)

Agreed - the condition is most definitely a partial rupture, or even a full rupture, with the short head still possibly providing some knee flexion acticity. MRI will provide definitive diagnosis, as stated in the other responses. Treatment should be functionally orientated - surgical intervention seems to give best results based on recent evidence.

Charlie K.



mpptmw -> Re: Hamstring tear (April 25, 2000 1:45:00 AM)

Keep in mind that the ability to palpatet the insertion does not rule our a tear. The majority of tears occur at the musculotendinous junction, not the osteotendinous junction, so the tendon would be palpable even with a severe tear.

One piece of advice, I would be tactful in my suggestion for an MRI. I am in private practice and market to the physicians in my area. One of the biggest complaints I get is that "PT's think they are doctors" and the thing that has been specifically mentioned is telling patients they need an MRI. While I am comfortable in making that determination at times, if I run all my doctors off, I won't have the opportunity because I will have no patients. So you may want to call the doctor before discussing this with the patient.



mcap -> Re: Hamstring tear (April 25, 2000 6:28:00 AM)

I agree with the above post.

Don't mention it to the patient and talk it over with the doctor first. I know it doesn't seem right but there has been several times that I thought something was going on and it was actually nothing. Got to be conscious of those referral relationships.

-mcap



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