A 42-Year-Old Woman with Sudden Hip Pain

Differential Diagnosis

• Hamstring avulsion
• Lumbosacral facet syndrome
• Lumbosacral radiculopathy
• Sacroilliac joint injury

Diagnosis

This patient sustained a hamstring avulsion. Diagnosis of such injuries is often missed or delayed, which results in complications such as sciatica, pain, weakness, stiffness, or even deformity.

 

Learnings/What to Look for

• Hamstrings are comprised of three muscles: the biceps femoris, the semitendinosis, and the semimembranosis
• Origin of the hamstrings is the ischial tuberosity
• Avulsion injury at the myotendinous junction causes a small sliver of bone to be separated, which visible on the radiograph.

 

Pearls for Urgent Care Management and Considerations for Transfer

• Management is conservative, with initial approach focused on pain relief with crutches, decreased activity and non-opioid analgesia
• Surgery is rarely required
• Follow up with orthopedics or primary care and return to activity within 4-6 weeks

 

Acknowledgment: Images courtesy of Teleradiology Specialists.