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Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations
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Editorial Commentary: Proximal Hamstring Syndrome: Another Pain in the Buttock
1Marina del Rey, California.
Summary
Proximal hamstring injuries, causing buttock pain and sciatica, may require surgical repair for severe avulsions. Less severe or chronic cases often respond to nonoperative management, with surgery reserved for recalcitrant conditions.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Musculoskeletal imaging
Background:
- Proximal hamstring injuries present with buttock pain, weakness, and sciatic neuralgia.
- Avulsion ruptures with significant retraction (>2 cm) may benefit from open surgical repair.
- Chronic proximal hamstring syndrome can lead to posterior thigh and sit pain due to scar entrapment.
Discussion:
- The optimal surgical approach for recalcitrant proximal hamstring syndrome (tenotomy, debridement, repair, neurolysis) remains undetermined.
- Endoscopic surgery is evolving, currently indicated for ischial bursectomy, debridement, and sciatic neurolysis.
- Endoscopic repair is feasible for mild tears, but its role in acute complete tears or partial tears is controversial.
Key Insights:
- Early open surgical repair is recommended for avulsion ruptures with >2-cm retraction.
- Nonoperative management is often effective for chronic proximal hamstring syndrome and less severe tears.
- Surgical intervention, whether open or endoscopic, should be considered for patients who fail conservative treatment.
Outlook:
- Further research is needed to establish the most effective surgical procedures for chronic proximal hamstring syndrome.
- The indications and long-term outcomes of endoscopic proximal hamstring surgery require further investigation.
- Developing standardized surgical protocols will improve patient outcomes for proximal hamstring injuries.
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