Hamstring Tendon Tear

The hamstring muscle group consists of three tendons: the semitendinosus, semimembranosus, and biceps femoris. These muscles are crucial for walking, running, and jumping and play a vital role in bending the knee and extending the hip. The proximal hamstring tendon connects the three muscles to the pelvis bone at the ischium. Hamstring tendon tears are injuries to one or more tendons that attach the hamstring muscles at the back of the thigh to the pelvis and leg.

Hamstring injuries can occur in different locations, such as within the hamstring muscle itself or at the proximal hamstring tendon, near the buttock, where the tendon attaches to the pelvis. Injuries to the proximal hamstring tendon can range from partial tendon tears to complete ruptures or tendon detachment.

Proximal hamstring tendon tears are common in sports that involve sprinting, sudden acceleration, deceleration, and explosive movements. Injuries to the hamstring tendon can occur with acute trauma, such as falls, especially with the legs apart in the split position. Finally, repetitive microtrauma and overuse can result in proximal hamstring tearing.

Proximal hamstring tendon tears occur due to:

• Overuse: Repeated stress on the hamstring tendons can lead to tears, commonly seen in athletes who participate in sports that require sprinting, jumping, or sudden stops and starts, such as soccer, basketball, and track and field.
• Acute Injury: Acute hamstring injuries often occur in sports that involve repetitive kicking or high-speed sprinting, such as football, rugby, and athletics. They can also occur with sports such as water skiing and surfing or in the event of a fall where the legs separate or go into the splits.
• Muscle Imbalance: If the muscles around the thigh and pelvis are not equally strong, it can put additional stress on the hamstring tendons, ultimately leading to tears.
• Flexibility Issues: Poor flexibility can increase the risk of a hamstring injury, as tight muscles can be more prone to tearing.
• Previous Injury: A history of hamstring injuries can increase the risk of recurrent injury, resulting in a proximal hamstring tendon tear.

The symptoms of a hamstring tendon tear may include:

• Sudden, sharp pain in the back of the thigh near the buttock.
• A popping or snapping sensation at the time of injury, indicating a severe tear.
• Tenderness at the point of injury.
• Swelling and bruising may develop within the first few hours or days after the injury.
• Weakness in the hamstring muscle makes walking or bending the knee difficult.

Your UCSF Women’s Sports Medicine physician will review your medical history, including any previous hamstring injuries, and inquire about your injury’s circumstances and symptoms.

They will examine for bruising, swelling, weakness, and tenderness. Imaging tests such as X-rays and MRIs are commonly used to confirm the diagnosis and assess the severity of the injury. These tests provide detailed pictures of the soft tissues and bone and can help identify the location and extent of a tear.

Treatment for proximal hamstring tendon injuries depends on the severity of the injury. Low-grade injuries involving one tendon are treated with non-operative treatments such as rest, physical therapy, pain management, and gradual return to activities. Partial tendon tears involving 2 tendons can be either treated non-operatively or with surgery, depending on the individual patient and degree of tearing. Full thickness or three tendon proximal hamstring ruptures are generally treated with proximal hamstring repair surgery in younger, active patients to restore their ability to do sports or impact activities.