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Farfán E, Rojas S, Olivé-Vilás R, Rodríguez-Baeza A. Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication. Surg Radiol Anat 2024; 46:749-760. [PMID: 38652253 DOI: 10.1007/s00276-024-03371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The hamstrings muscles are innervated by sciatic nerve branches. However, previous studies assessing which and how many branches innervate each muscle have yielded discrepant results. This study investigated the innervation patterns of hamstrings. MATERIALS AND METHODS Thirty-five cadaver limbs were investigated. The average age of subjects was 78.6 ± 17.2 years, with 48.6% male and 51.4% female, while 57.1% were right limbs and 42.9% left. The sciatic nerve, hamstrings and associated structures were dissected. The number of nerve branches for each muscle and the level where they penetrated the muscle were recorded. RESULTS The sciatic nerve was connected by a fibrous band to the long head of the biceps femoris. This muscle was innervated by either one or two branches, which penetrated the muscle into its superior or middle third. The short head of the biceps femoris was innervated by a single nerve that usually penetrated its middle third, but sometimes inferiorly or, less commonly, superiorly. The semitendinosus was always innervated by two branches, the superior branch penetrating its upper third, the inferior mostly the middle third. The semimembranosus usually was innervated by a single nerve branch that penetrated the muscle at its middle or lower third. Four specimens revealed common nerves that innervated than one muscle. CONCLUSIONS We have characterized hamstring innervation patterns, knowledge that is relevant to neurolysis, surgery of the thigh, and other procedures. Moreover, a mechanical connection between the sciatic nerve and biceps femoris long head was identified that could explain certain neuralgias.
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Affiliation(s)
- Emilio Farfán
- Anatomy Department, Medicine School, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins #340, Santiago, Chile.
| | - Santiago Rojas
- Department of Morphological Sciences (Human Anatomy and Embryology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Olivé-Vilás
- Sports Medicine Department, Consorci Sanitari de Terrassa- CAR Sant Cugat, Barcelona, Spain
- Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alfonso Rodríguez-Baeza
- Department of Morphological Sciences (Human Anatomy and Embryology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kluckman M, Nardini S, Katta A, McCarrell J, Byerly D. The direct muscular origin of the semitendinosus: a pitfall in categorization of proximal hamstring tendon tears. Skeletal Radiol 2024; 53:1011-1018. [PMID: 37740078 DOI: 10.1007/s00256-023-04455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
The ischial origin of the hamstring musculature is complex. While the conjoint tendon and semimembranosus are commonly discussed and understood by radiologists, there is a lesser-known origin of the semitendinosus along the inferior and medial surface of the ischium in the form of a broad direct muscular connection. This secondary origin is infrequently described in the radiology literature and is a potential pitfall during grading of semitendinosus injuries if the interpreting physician is unaware of its presence. In a proximal hamstring tendon tear, the direct muscular origin of the semitendinosus can be spared, torn along with the conjoint tendon, or remain intact and contribute to a vertical shearing injury of the semitendinosus myotendinous junction. Detailed knowledge of this anatomy and its imaging appearance in the setting of injury enables the reader to correctly diagnose these unique hamstring injuries.
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Affiliation(s)
- Matthew Kluckman
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort San Houston, TX, 78234, USA.
| | - Steven Nardini
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort San Houston, TX, 78234, USA
| | - Asish Katta
- University of the Incarnate Word School of Osteopathic Medicine, 7615 Kennedy Hill Dr, San Antonio, TX, 78235, USA
| | - Jerod McCarrell
- University of the Incarnate Word School of Osteopathic Medicine, 7615 Kennedy Hill Dr, San Antonio, TX, 78235, USA
| | - Douglas Byerly
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort San Houston, TX, 78234, USA
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Ekstrand J, Bengtsson H, Waldén M, Davison M, Khan KM, Hägglund M. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men's professional football: the UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br J Sports Med 2022; 57:bjsports-2021-105407. [PMID: 36588400 PMCID: PMC9985757 DOI: 10.1136/bjsports-2021-105407] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To: (1) describe hamstring injury incidence and burden in male professional football players over 21 seasons (2001/02 to 2021/22); (2) analyse the time-trends of hamstring muscle injuries over the most recent eight seasons (2014/15 to 2021/22); and (3) describe hamstring injury location, mechanism and recurrence rate. METHODS 3909 players from 54 teams (in 20 European countries) from 2001/02 to 2021/22 (21 consecutive seasons) were included. Team medical staff recorded individual player exposure and time-loss injuries. Time-trend analyses were performed with Poisson regression using generalised linear models. RESULTS 2636 hamstring injuries represented 19% of all reported injuries, with the proportion of all injuries increasing from 12% during the first season to 24% in the most recent season. During that same period, the percentage of all injury absence days caused by hamstring injuries increased from 10% to 20%. Between 2014/15 and 2021/22, training hamstring injury incidence increased (6.7% annually, 95% CI 1.7% to 12.5%) as did burden (9.0% annually, 95% CI 1.2% to 18.3%). During those years, the match hamstring injury incidence also increased (3.9% annually, 95% CI 0.1% to 7.9%) and with the same trend (not statistically significant) for match hamstring injury burden (6.2% annually, 95% CI -0.5% to 15.0%). CONCLUSIONS Hamstring injury proportions-in number of injuries and total absence days-doubled during the 21-year period of study. During the last eight seasons, hamstring injury rates have increased both in training and match play.
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Affiliation(s)
- Jan Ekstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Håkan Bengtsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michael Davison
- FIFA Medical Centre of Excellence, London, Isokinetic Medical Group, London, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Hägglund
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Xu J, Fu D, Peng Y, Yang P, Xiong R, Lei K, Guo L. A case report: anatomical translocation in tibial insertion of semitendinosus tendon after tibial lengthening. BMC Musculoskelet Disord 2022; 23:936. [PMID: 36303198 PMCID: PMC9615355 DOI: 10.1186/s12891-022-05890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is the most common method for arthroscopic anterior cruciate ligament (ACL) reconstruction by using the semitendinosus and gracilis tendons and single-tunnel technique. However, anatomic translocation of hamstring tendon attachment is very rare. Case presentation A 45-year-old male who need to receive right knee ACL reconstruction due to sprain injury while playing table tennis was found to have a translocation at tibial attachment of semitendinosus tendon. The tibial insertion of left semitendinosus was then explored by ultrasound and found to be identical to the contralateral limb. The patient has a history of bilateral tibial lengthening. Conclusions This is the first case as far as we know that reported anatomic translocation of the tibial attachment of the hamstring tendon after tibial lengthening. Surgeons should be aware of this specific situation when hamstring tendon need to be harvested to avoid unnecessary complications.
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Affiliation(s)
- Juncai Xu
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Dejie Fu
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Pengfei Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Ran Xiong
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Kai Lei
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
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Widodo AF, Tien CW, Chen CW, Lai SC. Isotonic and Isometric Exercise Interventions Improve the Hamstring Muscles’ Strength and Flexibility: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10050811. [PMID: 35627948 PMCID: PMC9140507 DOI: 10.3390/healthcare10050811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Hamstring weakness has been associated with an increased risk of hamstring strain, a common sports injury that occurs when athletes perform actions such as quick sprints. The hamstring complex comprises three distinct muscles: the long and short heads of the bicep femoris, the semimembranosus, and the semitendinosus. Methods: The researchers collected the data from different electronic databases: PubMed, Google Scholar, and the Web of Science. Results: Many studies have been conducted on the numerous benefits of hamstring strength, in terms of athletic performance and injury prevention. Isotonic and isometric exercises are commonly used to improve hamstring strength, with each exercise type having a unique effect on the hamstring muscles. Isotonic exercise improves the muscles’ strength, increasing their ability to resist any force, while isometric training increases strength and the muscles’ ability to produce power by changing the muscle length. Conclusions: These exercises, when performed at low intensity, but with high repetition, can be used by the healthy general population to prepare for training and daily exercise. This can improve hamstring muscle strength and flexibility, leading to enhanced performance and reduced injury risk.
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Affiliation(s)
- Akhmad Fajri Widodo
- International Sport Science Master’s Program, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
| | - Cheng-Wen Tien
- Physical Education Office, General Education Centre, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
| | - Chien-Wei Chen
- International Sport Science Master’s Program, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Department of Exercise and Health Science, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Correspondence:
| | - Shih-Chiung Lai
- Department of Exercise and Health Science, College of Human Development and Health, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
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