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Proximal Hamstring Tendinopathy (PHT) - Coggle Diagram
Proximal Hamstring Tendinopathy (PHT)
Objective
Neuro examination should be clear.
We would likely see more ROM and less pain during PROM as there is not the contractile element of AROM.
May see a reduction in ROM and strength but this is likely to be limited by pain.
Can have diffuse or referred pain.
May be muscle wastage present.
Pain on palpation of ischial tuberosity.
May present with poor proximal stability.
Subjective
Pain usually highly localized over ischial tuberosity (attachment site). pt can often point to this area.
Pain pattern = worse in AM or when starting activity, may then improve and then will return or feel worse 24 hours later.
Common in athletes and sports such as running and football. Also present in stretching like, yoga or Pilates.
Aggs = sitting, driving, squatting, lunges, stairs (anything with hamstring involvement).
May indicate a sudden increase in activity.
Insidious
Tests
PSLR and Slump test to rule out Sciatic (may be too painful).
Clear knee and lumbar spine.
Modified bent knee stretch test (Sens 89%, Spec 91%) for PHT. Supine, fully flex hip and knee, quickly extend knee.
Research
Consensus - activity modification followed by load programme.
Dr Peter Malliaras - key player
Treatment: Cacchio et al (2011) found radial shockwave treatment effective combined with rehabilitation programme – at 12 month follow-up, results superior
Treatment
Long term management. 3-6 months.
Patient education key here.
Activity modification with load management programme.
Pathology
Typical over use injury, which has developed over time.
Chronic.
Disruption of collagen fibres - failed healing response of tendon.
Why this and not differential?
The absence of referring or neuro like symptoms.
The repetitive nature of movements in Hx.
The localised pain and increase activity would give more weight to tendinopathy.
Pain pattern and agg factors.
Absence of trauma.
Differentials
Referred pain from lumbar. Clear lumbar. Absence of back pain.
Sciatic nerve (deep gluteal syndrome). Presence of neuro like symptoms. Slump expect positive.
SI joint pain - Rule both in and out with "Cluster of Laslett" (Sens 88%, Spec 78%) supine ASIS pressure dorsal, supine hand under sacrum longitudinal pressure through femur in knee/hip flexed pos, Side lying Ant rim ilium vertical thrust, prone dorsal pressure on S2. All applying thrusts with increasing pressure, positive pain provocation = 2/4.
Tears or ruptures of hamstring. Clear MOI (not insidious), pop.
Ischiofemoral impingement.