Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Proximal Hamstrings at the Ischial Tuberosity

The hamstring muscle complex comprises several biarticular posterior thigh muscles. These muscles originate from the ischial tuberosity and attach distally to the knee. Hamstring muscle injuries are among the most common in the lower extremities of active individuals. Hamstring injuries follow a consistent pattern and medical history, including a sudden, explosive movement (sprinting, kicking, jumping, or lunging). The onset of pain is usually acute in the proximal posterior aspect of the upper thigh. Injured individuals may describe a “pop” or “snap” or a sensation as if someone kicked them in the back of the thigh. An accurate diagnosis of proximal hamstring overuse, partial tears, or ruptures is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative, gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating proximal hamstring injuries, including tendinopathy, muscle strains (partial tears), and ruptures. MSKUS is excellent at detecting changes in tendon and muscle composition and continuity. This manuscript will review the utility of MSKUS in evaluating proximal hamstring tendon and muscle injury, including anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with hamstring injuries.