Hamstring Avulsion (complete tear from pelvis)

[janemarie]

Dear Ball coach,

I for one had a complete hamstring avulsion and did not have any bruising at all!!! no kidding not one black and blue nothing nada!!! When I went to the orthopedic surgeon he was a little stumped however he insisted on a mri to see if there was an avulsion. ( I would push for a mri.) I could walk with a limp although it hurt I was mobile. The treatment is not the same for no avulsion vs complete avulsion. If you go back to one of the earlier posting around maybe page 30ish (its a link from one the the members posting) there is a paper by the surgeon who did my surgery as well as quite a few on this site. It spells out when and when not you do surgery based on the 2 authors of the paper/ I for one cannot imagine how the hamstring could ever heal correctly without reattachment. Scar tissue will form the hamstring will retract and activities of daily living will be much more difficult. Given your age and your activity level you will want to know asap.
My original orthopedic surgeon told me the same thing. avulsions are not really treated with surgery just ice and rest and p.t I am a nurse and did a little digging on the internet as it did not make sense to me that the hamstring could reattach as well and as strong without surgery. You have to be your own advocate. I found the surgeon contacted him. My orthopedic just had never heard of reattachment of the hamstring. So do some digging get the mri and pursue what you need to do. Maybe you will be lucky and it will just be a strain or a tear not an avulsion. But follow your instincts. If you read the paper it sites a group of patients who were either misdiagnosed or opted not to have surgery. The outcome is not great. Tons of problems and some of them ended up getting the surgery a few years later. Much more difficult the longer you wait.

I am not an advocate for any surgery but when the outcome could be far greater then without it then one must consider it. You always have to weight the risks vs the benefits. But if you do not have all the information you cannot make and informed decision.

Good luck
Janemarie

[janemarie]

Dear ball coach,
I could not find a surgeon who does this surgery in my state./ I had to go to Philadelphia to have it done. So you may have to travel to find a surgeon. Hopefully someone from this site has had it done in Colorado and can give you some advice if it comes down to you needing the surgery

Janemarie

[I Fell]

Ball Coach

I would push for the MRI. There are too many stories on here of people who were told the same thing as you and months and years later end up needing the surgery. The surgery is easier for both you and the surgeon the sooner it was done. I had a lot of brusing but could function very well and had good strength 3 weeks after the accident. Here is the link to the paper that Jean Marie referred you to. Ventued even ran 4 half-marathons and the NY marathon before he had his repair done 2 years after his avulsion. So being able to walk is not an indicator of no avulsion. I would push for an MRI. This is the paper written by the doctor that did my surgery, Jack B and Jean Marie. Jay had his done by the co-author. Results have been good.

Good luck.

Heal well.

http://jdc.jefferson.edu/cgi/viewcon...ontext=orthofp

[BallCoach]

Thank you so much, I Fell and JaneMarie, for your quick response to my questions! I think I will push for an MRI, maybe initially through my GP? Although he won't have experience with the injury/repair per se, I'm assuming the MRI be read by a radiologist who will determine the extent of the injury? That way, if it's not an avulsion injury, I won't proceed, but if it is, I'll find a surgeon. How do you recommend finding out if any surgeons in my area have worked with this? Do I just ask the receptionists when I call? Is there some sort of online referral source that I could work with?

This site has been so helpful. I really appreciate the input!

[janemarie]

Dear ball coach.
The radiologist will read the mri and give a report back to the your Gp or to your orthopedist. The paper that I mentioned in the previous post has the names of the two surgeons one in Philly and one in Pittsburg. I would call them to see if they know anyone in the Colorado area that might do the surgery. I think it is a small network of mds who do this. When I went to find a surgeon in the D.C baltimore area I called the 2 surgeons from the paper and they did not know of anyone in my area who had done this surgery thus far. You will most likely need to seek a orthopedic surgeon who works with the professional football or baseball or soccer teams in your area, My surgeon was a ortho for the phillies. Not to many general orthopedic surgeons have seen this type of injury and may feel that surgery is not needed. Maybe if you google hamstring avulsion and then type in surgeon maybe you will get a hit.

Good luck
Janemarie

[Dayna]

Dear Ball Coach.

I am currently three weeks post-surgery for a complete hamstring avulsion. My injury occurred September 8th; my surgery was October 12th. I was taken to the emergency room of my local hospital immediately after my fall and within two days had seen a sports medicine orthopedic D.O. At the time of the injury and for the days immediately thereafter I was in an extreme amount of pain. Neither the physician's assistant at the E.R. nor the D.O. ordered x-rays or any other tests; however, they did send me to physical therapy, recommended icing, rest and ibuprofen. Like you, I had very little bruising and after a few weeks I was able to walk almost without a limp, but with every step I took I could feel my muscle "flop" in my lower thigh, and I was uncomfortable the few times I attempted to drive my standard transmission automobile. I knew something wasn't right. It wasn't until I showed my D.O. my "hanging thigh" at my discharge appointment that he seemed genuinely concerned and ordered an MRI. After confirmation of a complete avulsion, with a little help from my D.O. but a lot of leg work of my own, I found a surgeon I had confidence in who was willing to do the repair within just a few days.

I am 54 years old and fairly active, though not at all an athlete. I want to be able to bike and walk and snowshoe and hike unimpeded. Once I knew the extent of my injury there was no question in my mind but that I would have the surgery. As I said once before in this forum, there's a reason those muscles are there and attached the way they are. I felt the compromise without surgery would just be too great, not to mention the problems that can develop if the surgery is not done. I agree completely with I Fell and Janemarie. Your best advocate is yourself. Get the MRI. And if you choose surgery, check out college team orthopedic surgeons. The decision on whether or not to have the repair is, I know, personal, but just three weeks after surgery and with weeks yet on crutches and a lot of physical therapy ahead of me, Im sure, absolutely sure I made the right decision.

Best of luck,
Dayna

[Jay M]

BallCoach,
First, let me say that I had a similar experience. All the symptoms you had (loud pop and severe pain) at injury are very common with hamstring injuries and specifically avulsions. I too,went to my family doctor initially and was told that it was basically a hamstring strain and that it would eventually heal by itself. This is very common with this injury because of its rarity. I fortunately, like you, had an idea that something more than a strain was going on. I was very persistent (demanding) that I receive an MRI. My M.D. simply didn't think it was necessary. I finally convinced him to do an MRI, which shaowed that I had a nearly completely avulsed hamstring. All but one of the tendons were detached and the remaining tendon only was hanging in there by threads. I had absolutely no bruising and also walked with a limp.
My recommendation would be to be a really big "pain in the ass" (no pun intended) until your M.D. will agree to do an MRI. An MRI is the only way to know for sure whether you've had an avulsion. If he will not agree to it try different M.Ds until one will agree to it. As far as finding an orthopedic M.D. with experience in this rare injury, I would recommend seeking the professional sports team's orthopedic surgeon in your area. They will almost certainly have experience with this injury. I was fortunate enough to have the Pittsburgh Steeler's surgeon do my surgery.
You may luck out and only have a hamstring strain, however, I would not personally want to leave this to luck. There is a limited time frame (2 months) to have surgery without extensive scar removal as part of the surgery. In fact, many surgeons will not even do this surgery once significant scarring and atrophy occurs.
Kudos to your trainer for recognizing the possibility of avulsion. As a side note, although not its not a "for sure" method to diagnose an avulsed hamstring, one way to suspect it is if the hamstring muscle belly is not taut like the other. If the hamstring feels like soft and "wimpy" when trying to activate it, this can be a sign of an avusion.
I hope this information helps. Keep us updated and feel free to ask any questions you may have. Hopefully, someone can help or guide you in the right direction.

Good luck,
Jay

[Love2Run]

Just got back from PT (8.5 weeks post op) and the progress with my hamstring is coming along nicely. Flexibility and function appear to be fine. However, when he tested the flexibility of (slightly) flexing my knee to my chest there was very little give. This might explain why I feel the 'rubber band' feeling around my leg when I walk. PT doc says it is likely the stiffness of my hip muscles and ligaments (vs. my hamstring).

Anyone experience anything similar at this stage of recovery? Trying to keep positive but any sign of a potential issue, I get super nervous! Thanks all, Love2Run

[Jay M]

Love2Run,
What your experiencing is not uncommon. I too had, and still do have tightness in my hip adductors and piriformis muscle. Your body will sub-consciously do what is called guarding when a surrounding area is injured. Basically, it will tense up to protect the area that is injured. After prolonged guarding, the muscles will tighten up or shorten a little. This can cause tightness in surrounding muscle groups. I like many others had hip issues even months after surgery. Stretching when your PT gives you the OK should in time resolve the issues. If not, consult with your ortho.

Heal well,

Jay

[Love2Run]

Jay, thanks so much for your response. Calmed my nerves quite a bit to see that others have had this stiffness as well, and it makes me realize that I still have a good, long road to travel to attempt a full recovery!