Hamstring visualisation.

[Laura Thompson]

Hi Steve!

Great webinars thankyou. I work down in Tas where I find the majority of my patients for hamstring ultrasounds are middle aged-elderly and generally overweight.

Do you have an tips/tricks on patient positions to best evaluate the hamstrings in such patients? I find often in prone, I struggle to see enough depth and it can be a real arm killer. Its not uncommon for me to require the curved probe, however this doesn’t give much detail. If I lay them decub with legs bent I’m worried I will be missing tears. Also to do a contralateral comparison it takes about 5 minutes for them to roll over!

Thanks, Laura

[Stephen Bird]

Hi Laura,

Yes, we get them as well,

But interestingly not that commonly as sedentary people don’t tear hamstrings.

When I am faces with this situation it is no different to scanning a high BMI obstetric scan or high BMI abdominal scan.

It is a natural limitation of ultrasound.

So I go back to basics. Use a convex transducer (I like the Canon 10C3) but other convex transducers are good. Drop your frequency, reduce the sector width a bit, reduce the dynamic range a bit and turn the edge enhancement up a bit.

Then scan like any other hamstring.

Know your landmarks so you can navigate. Find the inscription in semitendinosus and use that as a key navigation landmark.

Be structured and methodical looking at one muscle at a time so you don’t get lost.

The scan won’t be pretty, but it should be diagnostic.

I do them prone as it makes comparison easy and I think I see things better.

As always if the scan is not diagnostic it is not your fault. Explain the scan limitations on the worksheet and they can do a follow up clinical assessment or an MRI if required.

The type of patients you describe often have clinical sciatica and no history of overstitching injury so they are inappropriate referrals to start with.

Another good clue is bruising. If there has been a fall or overstitching event and there is a clinical bruise the tear will be proximal to the bruise. The absence of a cruise often indicates there has not been a significant hamstring failure.

We are looking forward to getting back to Tassie next year to do the capes walk which was cancelled by covid.

You are lucky to live there,

Happy scanning,

Steve

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