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

Int J Sports Phys Ther. 2014 May;9(3):371-6.


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.

Keywords: Differential diagnosis; hamstring avulsion; imaging.