{"id":353,"date":"2022-05-02T09:00:22","date_gmt":"2022-05-02T08:00:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjopensem\/?p=353"},"modified":"2022-05-01T20:29:44","modified_gmt":"2022-05-01T19:29:44","slug":"clinical-tips-gustaaf-reurink-on-investigating-hamstring-tendon-avulsion","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjopensem\/2022\/05\/02\/clinical-tips-gustaaf-reurink-on-investigating-hamstring-tendon-avulsion\/","title":{"rendered":"CLINICAL TIPS… GUSTAAF REURINK ON INVESTIGATING HAMSTRING TENDON AVULSION"},"content":{"rendered":"

Fortnightly we invite a colleague to share a clinical tip with our community. Today, Gustaaf Reurink is on the stage.<\/strong><\/span><\/p>\n

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Who are you?\u00a0 <\/strong><\/h5>\n

I\u2019m a Sports Medicine Physician and a Human Movement Scientist. I\u2019m working at the Sports Medicine clinic in Academic hospital Amsterdam UMC and teaching hospital (OLVG Amsterdam) and at the professional football club AFC Ajax youth academy. I\u2019m also post-doc researcher at Amsterdam UMC.<\/p>\n

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What clinical tips would you like to share with the community?<\/strong><\/h5>\n

Hamstring tendon avulsions are the most severe hamstring injuries that impact sports participation and physical aspects of daily activities. Early recognition is crucial, as untreated (either conservatively or surgically) avulsion injuries may result in worse clinical outcome and long-term disability.<\/p>\n

Many textbooks and literature are available describing the typical clinical presentation of a hamstring tendon avulsion, including a trauma mechanism involving forced hip flexion combined\u00a0with knee extension and a popping sensation, severe pain, difficulty sitting, extensive bruising and a palpable gap.<\/p>\n

Despite this, we observe in our clinical practice and research that hamstring tendon avulsions are initially often missed.1<\/sup> I suspect an important reason is that many of the injuries do not present with the described \u2018typical\u2019 signs and symptoms. Some common pitfalls are: the injury mechanism may differ (e.g. forced abduction, only low impact trauma), bruising may occur only after several days, pain can be mild, knee flexion strength may persist by m. biceps femoris short head and\/or m. gastrocnemius activation and a palpable gap can be masked by extensive hematoma.<\/p>\n

I want to share another clinical sign that, in my experience, raises a high suspicion of a hamstring tendon avulsion, even in absence of the \u2018typical\u2019 symptoms: an inability to activate the hamstring muscles and loss of hamstring proprioception.<\/p>\n