Imaging Diagnosis and Prognostication of Hamstring Injuries. Related articles: Anatomy: Lower limb. Promoted articles advertising. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Loading Stack - 0 images remaining. By System:. Patient Cases. The hamstring muscle group plays a prominent role in hip extension posterior movement of the femur and knee flexion posterior movement of the tibia and fibula. The hamstring muscles also play an essential role as a dynamic stabilizer of the knee joint.
Operating in tandem with the anterior cruciate ligament ACL , the hamstrings resist anterior translation of the tibia during the heel strike phase of the gait cycle. A significant portion of lower extremity development occurs during weeks 4 to 8 of embryogenesis. Like all other skeletal muscle tissue, the hamstring muscles form from the embryonic mesoderm.
Migrating from the somites during the early embryonic phase, mesodermal cells differentiate into myoblasts, which duplicate and coalesce, eventually forming functional muscle tissue.
The hamstring muscle complex receives vascular supply from the perforating branches of the deep femoral artery, also known as the profunda femoris artery. The profunda femoris is a branch of the femoral artery.
The femoral artery is demarcated from the external iliac artery by the inguinal ligament. In general, the deep veins of the thigh share the same name as the major arteries which they follow. The femoral vein is responsible for a large degree of the venous drainage of the thigh. It accompanies the femoral artery and receives additional venous drainage from the profunda femoris vein.
Similar to the femoral artery, the femoral vein transitions to become the external iliac vein at the level of the inguinal ligament. The lymphatic drainage of the thigh also mirrors the arterial supply and eventually drains into the lumbar lymphatic trunks and cisterna chyli. The hamstring muscle complex is innervated by nerves that arise from the lumbar and sacral plexuses.
These plexuses give rise to the sciatic nerve L3-S4 , which bifurcates into the tibial and common peroneal fibular nerves at the level of the tibiofemoral joint. The tibial nerve innervates the semimembranosus, semitendinosus, and long head of the biceps femoris. The common peroneal branch of the sciatic nerve innervates the short head of the biceps femoris.
Although they are uncommon, surgeons must remain aware of hamstring muscle anatomical variations. The hamstring muscle group, except for the short head of the biceps femoris, typically originates from a conjoint muscle-tendon arising from the ischial tuberosity. Interestingly, there are reports which reveal variants where the semitendinosus and the long head of the biceps femoris appear from distinct tendinous origins.
There is also a report of a patient with bilateral absence of the semimembranosus muscles. It consists of two anatomical regions — fascicles in the superficial part are arranged longitudinally, predominantly arising from the lateral intermuscular septum, while those in the deeper distal part originate from all three proximal insertion sites, passing inferiorly at an acute angle.
This muscle has the longest fascicle length of all the hamstring muscles The distal insertion of this muscle is complex, consisting of six components — a muscular insertion into the tendon of BFlh, an expansion attaching both heads to the posteromedial aspect of the lateral collateral ligament, an insertion confluent with the iliotibial band and three tendinous arms to the posterolateral aspect of fibular head, joint capsule and the proximal, lateral tibia, respectively 9.
The innervation of BFsh differs to the rest of the hamstring muscles. Traditionally, the nerve supply to this muscle is considered to be from a single nerve branch arising from the common peroneal nerve Figure 5. However, it is probable that at least two muscle nerves supply the muscle one to each of the two muscle regions , with one branch originating directly from the sciatic nerve and the other from the common peroneal nerve 3.
The blood supply of BFsh is from the second or third perforating arteries of the deep femoral artery superiorly and from the lateral superior genicular artery inferiorly BFsh may be completely absent and rarely, the distal tendons of the long and short heads may be partially or entirely separate Semitendinosus, named in reference to its long cord-like distal tendon, is also distinguished by a tendinous inscription which divides its muscle belly into two separate regions.
This division is paralleled by its innervation, with two separate nerve branches supplying the superior and inferior parts of the muscle. Semitendinosus is commonly considered to arise from a common origin together with BFlh. However, upon closer inspection it has three distinct areas of insertion:. The strap-like muscle belly of ST is the longest of all of the hamstrings approximately 30 cm and is characterised by a tendinous inscription that divides the muscle into superior and inferior regions.
This complex three-dimensional layered structure serves as a staggered insertion site for fascicles which are generally oriented vertically and are of a similar length in both parts of the muscle 8 cm. It may provide added muscle-tendon interface area for its fascicles, reducing force concentration, therefore making it less susceptible to injury.
The consistency in fascicle length is mirrored by the identical size of both the superior and inferior regions with respect to volume. The long, thin distal tendon of ST 25 to 30 cm in length lies on the superficial surface of SM and passes along the medial aspect of the knee joint.
After curving around the medial tibial condyle and passing over the medial collateral ligament of the knee joint, the tendon of ST contributes to the pes anserinus, inserting into the medial surface of the tibia posterior to the attachment of sartorius and distal to that of gracilis. At its termination, it unites with the tendon of gracilis and gives off a prolongation to the deep fascia of the leg and the medial head of gastrocnemius Semitendinosus is supplied by one or two primary muscle nerves from the tibial nerve.
Whichever branching pattern is evident, one nerve branch always supplies the superior region of the muscle above the inscription and the other the inferior region below the inscription 3. Primarily, blood supply to ST is derived from either the medial circumflex femoral artery or from the first perforating artery; the inferior gluteal and medial inferior genicular arteries may provide an accessory supply The muscle bellies of ST and SM may be partially fused and accessory slips can arise from the coccyx, sacrotuberous ligament or iliotibial band Aberrant fascicles may connect to the fascia on the back of the thigh and rarely, fascicles may arise directly from the femur, a feature present in many birds 2.
Fascicles bridging the tendinous inscription are common. Semimembranosus is named after its extensive membranous proximal tendon. It is hypothesised that the length of its free tendon together with its tortuous course may render it vulnerable to stretch injuries. This muscle is the largest of all of the hamstrings. Semimembranosus attaches to the lateral part of the ischial tuberosity Figure 3.
Its tendon passes deep and obliquely to those of ST and BFlh and rapidly widens to become an expansive aponeurosis characterised by a thick and rounded lateral border and a flattened thin medial membranous edge, such that it is said to resemble the wing of a plane Figure 1b.
On the medial aspect of the thigh its membranous part cups around the strap-like muscle belly of ST, which is positioned superficially. Its free tendon constitutes about a third 11 cm of its total tendinous length with the remaining two-thirds forming the longest proximal MTJ mean 20 cm of all the hamstring muscles Table 1 3,6.
Semimembranosus becomes fleshy about mid thigh, distinctly lower than the other hamstrings. Its muscle belly is formed of three regions, the proximal two are unipennate in arrangement but the distal region is thick and bipennate Figure 5. In comparison to the other hamstrings, its fascicles are the shortest 5 cm in length and display the greatest pennation angle, arranged as such for greater force production.
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Van Holsbeeck, Joseph H. Musculoskeletal Ultrasound. ISBN: — Freehand three-dimensional ultrasound to assess semitendinosus muscle morphology. J Anat. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Ramon Balius. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Reprints and Permissions. Balius, R. Sonographic landmarks in hamstring muscles. Skeletal Radiol 48, — Download citation. Received : 30 July Revised : 27 February Accepted : 11 March Published : 17 April Issue Date : November Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search SpringerLink Search. Download PDF. Abstract The ultrasound examination of hamstrings inspires respect due to the connective complexity of their structures, particularly for sonographers who are not used to this kind of study. Introduction Ultrasound examination of the hamstring muscles involves a demanding technique and an in-depth anatomical knowledge of the area.
Full size image. Ultrasound examination Classically, ultrasound examination of the hamstrings has preferably used osseous landmarks [ 5 , 16 , 17 , 18 , 19 ] or prior knowledge of topographic muscle anatomy [ 12 , 20 , 21 ].
Examination position and probe The patient is placed in the prone position, with their feet hanging off the edge of the table.
Areas of study The sonographic study of the hamstrings looks like an inverted tuning fork, marking four areas of interest with specific landmarks Fig. Discussion We strongly believe that our article offers a novel approach because it analyzes ecographic landmarks that have not been bibliographically referenced until now and makes an attempt to group all of them globally. MP4 , kb. References 1. Article Google Scholar 2.
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