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Perspective | Less Is More

A Proximal Hamstring Injury—Getting Off a Slippery Slope

Michael J. Barry, MD1; William E. Palmer, MD2; Alex J. Petruska, PT, SCS, LAT3
[+] Author Affiliations
1John D. Stoeckle Center for Primary Care Innovation, General Medicine Division, Massachusetts General Hospital, Boston
2Department of Radiology, Massachusetts General Hospital, Boston
3The Sports Physical Therapy Service, Massachusetts General Hospital, Boston
JAMA Intern Med. 2016;176(1):15-16. doi:10.1001/jamainternmed.2015.6795.
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On a hot July night in 2011, at age 58 years, I (M.J.B.) lunged for a perfectly hit tennis ball and felt sudden, severe pain in the back of my right thigh. I immediately collapsed and landed in a plume of red clay. Over the next few days, I was able to bear weight with the help of a cane, though I noticed numbness and impressive bruising down the back of my right leg. Obviously, I had injured my hamstring muscles and likely the posterior cutaneous femoral nerve as well. Being inherently conservative and wanting to avoid overmedicalization, I called my primary care physician, who referred me for a physical therapy consultation.

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Fluid-Sensitive Magnetic Resonance Imaging Scans

A, The image of the thigh shows that the conjoint semitendinosis-biceps femoris tendon (arrowhead) is ruptured, retracted from ischial tuberosity, and surrounded by hemorrhage. B, The image of the thigh shows edema of semitendinosis and biceps femoris muscles (arrowheads) and hemorrhage in surrounding fascial planes. F indicates femur.

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