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Condition/Disorder Synonyms

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  • Pulled hamstring

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ICD-9-CM Code

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  • 848.9 Unspecified site of sprain and strain

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ICD-10-CM Code

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  • T14.9 Dislocation, sprain, and strain of unspecified body region

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Key Features

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Description

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  • Stretch injury to biceps femoris or semimembranosus resulting in disruption of muscular or musculotendinous units

    • Grade I: mild

    • Grade II: moderate

    • Grader III: severe to complete tear or rupture

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Essentials of Diagnosis

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  • Diagnosis made with patient history and clinical findings or with imaging

  • Pain with resistance

  • Location of Lesion May Influence Prognosis

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General Considerations

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  • Mechanisms of injury1

    • Deceleration during swing phase while running

      • Typically occurs during high-speed running

      • Involves intramuscular tendon or aponeurosis of biceps femoris (long head), semitendinosus (secondary injury)

    • Excessive stretch while dancing or kicking

      • Typically during extreme hip flexion with full knee extension

      • Injury at proximal tendon of semimembranosus

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Demographics

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  • Previous hamstring injury is a strong predictor of recurrence

  • Athletes in high-speed-demand sports (e.g., football, track, rugby, soccer)

  • Athletes in sports/competition involving kicking or extreme hip flexion and knee extension (e.g., dancing, water-skiing)

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Clinical Findings

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Signs and Symptoms

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  • Acute-onset pain at proximal hamstring during high-speed running, often with audible pop, typically early or late in athletic event

  • Pain at ischial tuberosity with sitting

  • Decreased range of motion (ROM) in knee and hip

  • Decreased strength with knee flexion and hip extension

  • Tenderness to palpation (possible palpable lesion) at proximal tendon or musculotendinous junction

  • Tenderness may occur along muscle belly proximal to ischial tuberosity

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Functional Implications

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  • Inability to run or sprint

  • Inability to sit without limitation from pain

  • Inability to flex hip with knee fully extended

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Possible Contributing Causes

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  • Previous history of hamstring injury

  • Explosion activity without proper warm-up

  • Muscle imbalance between quadriceps and hamstring

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Differential Diagnosis

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  • Adverse neural tension

  • Adductor muscle strain

  • Avulsion fractures at ischial tuberosity

  • Lumbar radiculopathy

  • Sacroiliac dysfunction

  • Sciatica

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI for soft tissue

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Findings and Interpretation

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  • MRI can reveal area of fluid accumulation and location of lesion

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Treatment

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Medication

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  • NSAIDs

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Medical Procedures

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  • Surgery to repair grade-III strain or avulsion

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Referrals/Admittance

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  • To hospital for imaging (MRI)

  • Surgery (if grade-III strain)

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Impairments

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  • Inability to run or sprint

  • Inability to sit without limitation from pain

  • Inability to flex hip with knee fully extended

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Tests and Measures

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