DOCSLIB.ORG

Hip Anatomy and Ultrasound Scanning Technique

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hip Anatomy and Ultrasound Scanning Technique Hip Anatomy and Ultrasound Disclosures: Scanning Technique • Consultant: Bioclinica • Advisory Board: Philips Jon A. Jacobson, M.D. • Book Royalties: Elsevier Professor of Radiology • Not relevant to this talk Director, Division of Musculoskeletal Radiology University of Michigan Note: all images from the textbook Fundamentals of Musculoskeletal Ultrasound are copyrighted by Elsevier Inc. Sonographic Technique: hip and thigh Technique • Hip: – Anterior: hip joint, musculature, iliopsoas bursa 1. Start with low frequency transducer: – Lateral: gluteal tendons, bursae global, complete examination – Posterior: external rotators 2. Familiarize with anatomy – Other: symphysis pubis, inguinal hernia 3. Compare to contralateral side • Thigh: 4. Consider dynamic imaging – Anterior: quadriceps femoris – Medial: abductors – Posterior: hamstring Hip: anterior recess Sonographic Technique: Hip • Anterior and posterior layers • Anterior – Hip joint – Fibrous tissue + minute layer of synovium – Anterior musculature – Hyperechoic Radiology – Snapping iliopsoas – Each 2 - 4 mm thick 1999; 210:499 – Iliopsoas bursa – Lateral femoral cutaneous nerve • Transducers: – 10 – 12 MHz linear – <10 MHz curvilinear if needed 1 Hip: anterior recess Hip Joint Anterior Posterior Femur Femur Transverse Iliopsoas A Complex Sonographic Technique: Hip AIIS • Lateral – Greater trochanter A Ilium B – Gluteal tendons – Bursae – Snapping hip • Transducers: Pubis – 10 – 12 MHz linear Femoral Head – <10 MHz curvilinear if needed From: Guillin R. et al. Eur Rad Short Axis 2009; 19:995 Greater Trochanter: gluteal tendons Greater Trochanter Lateral Anterior Posterior FACETS: AF = anterior; LF = lateral; SPF = superoposterior; PF = posterior Gluteus medius (red) Gluteus minimus (blue) Pfirrmann et al. Radiology 2001; 221:469 2 Greater Greater Trochanter Trochanter Yellow arrow = gluteus medius White arrow = Inferior 12 gluteus minimus Anterior Posterior Yellow arrow = gluteus medius Axial MRI White arrow = gluteus minimus 3 Superior 4 Greater Trochanter Gluteus Minimus and Medius: Long Axis Subgluteus Gluteus Medius Medius Gluteus Gluteus Gluteus Bursa Minimus TFL Medius Minimus Trochanteric Bursa Glut Subgluteus Max Minimus Bursa LF AF PF PF AF: anterior facet LF: lateral facet PF: posterior facet Gluteus Minimus: Long Axis Gluteus Medius: Long Axis Iliotibial Tract Gmed Gmed LF AF Anterior Lateral Facet Facet 3 Posterior Thigh: anatomy Sonographic Technique: Thigh • Posterior: – Semimembranosus – Semitendinosus – Biceps femoris • Long and short heads – Sciatic nerve • Transducers: – 10 – 12 MHz linear – <10 MHz curvilinear if needed From: Netter’s Atlas of Human Anatomy Proximal Hamstring: gluteal fold Proximal Hamstring: gluteal fold to ischial tuberosity 1 2 3 Conjoint Medial Tendon ST ST BF Gluteal fold Moving proximal SM 4 Note: Long Axis Semimembranosus Adductor tendon (yellow Sciatic Magnus Nerve arrow) moving Transverse medial to lateral Note: Conjoined semitendinosus (ST) and biceps femoris long head (BF) tendon (yellow arrow), semimembranosus (SM blue arrow), and sciatic nerve in a triangle configuration *Conjoined ST-BF and SM tendons Ischial tuberosity only seen together in long axis when *Toggle transducer to eliminate anisotropy* they cross over distal to tuberosity Posterior Thigh: A Conjoined ST-BF Proximal hamstring: at ischial tuberosity Tendon proximal hamstring Conjoined ST-BF Tendon A SM Ischium Sciatic Nerve B B Semimembranosus SM Sacrotuberous Ischium Ligament Ischium Lateral Medial Ischium Transverse Lateral Medial Transverse 4 Posterior Thigh: Semitendinosus Raphe Posterior Mid Thigh: moving distal ST ST BF BF BF SM SM SM Sciatic Nerve Lateral Medial Lateral Medial BF SM Transverse BF SM Transverse Note: tapering of Note: hyperechoic raphe or veil that moves obliquely through semitendinosus semitendinosus muscle in proximal thigh over SM Posterior Mid Thigh: moving distal ST ST Posterior Thigh: longitudinal SM SM Lateral Medial Transverse SM SM Note: tapering of Sciatic Nerve Hamstring Origin semitendinosus over SM Take-home points: • Know bone landmarks • Hip evaluation: – Anterior: hip joint – Lateral: greater trochanter • Thigh: focused examination Syllabus on line and other educational material: www.jacobsonmskus.com Twitter handle: @jjacobsn 5.
Load more

Recommended publications
  • Muscle Length of the Hamstrings Using Ultrasonography Versus Musculoskeletal Modelling
    Journal of Functional Morphology and Kinesiology Article Muscle Length of the Hamstrings Using Ultrasonography Versus Musculoskeletal Modelling Eleftherios Kellis * , Athina Konstantinidou and Athanasios Ellinoudis Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100 Serres, Greece; [email protected] (A.K.); [email protected] (A.E.) * Correspondence: [email protected] Abstract: Muscle morphology is an important contributor to hamstring muscle injury and malfunc- tion. The aim of this study was to examine if hamstring muscle-tendon lengths differ between various measurement methods as well as if passive length changes differ between individual hamstrings. The lengths of biceps femoris long head (BFlh), semimembranosus (SM), and semitendinosus (ST) of 12 healthy males were determined using three methods: Firstly, by identifying the muscle attach- ments using ultrasound (US) and then measuring the distance on the skin using a flexible ultrasound tape (TAPE-US). Secondly, by scanning each muscle using extended-field-of view US (EFOV-US) and, thirdly, by estimating length using modelling equations (MODEL). Measurements were performed with the participant relaxed at six combinations of hip (0◦, 90◦) and knee (0◦, 45◦, and 90◦) flexion angles. The MODEL method showed greater BFlh and SM lengths as well as changes in length than US methods. EFOV-US showed greater ST and SM lengths than TAPE-US (p < 0.05). SM length change across all joint positions was greater than BFlh and ST (p < 0.05). Hamstring length predicted using regression equations is greater compared with those measured using US-based methods. The EFOV-US method yielded greater ST and SM length than the TAPE-US method.
    [Show full text]
  • Anatomical Variation of the Semitendinosus Muscle Origin
    eISSN 1308-4038 International Journal of Anatomical Variations (2013) 6: 225–227 Case Report Anatomical variation of the semitendinosus muscle origin Published online December 28th, 2013 © http://www.ijav.org Patrick Richard FRASER Abstract Addison Reed WOOD During a routine dissection of an 87-year-old female cadaver, an aberrant muscle attachment (AMA) of the right semitendinosus (ST) muscle origin was discovered medial to the primary Armando Aviles ROSALES muscle origin. This attachment originated from the medial portion of the ischial tuberosity and inferior to the sacrotuberous ligament attachment site. It then traveled distally in the long axis Department of Cell Biology and Anatomy, University of of the femur to join the ST muscle, which showed no other variations in structure. Variation in hamstring muscle origins has been shown to predispose patients to hamstring strains and North Texas Health Science Center, 3500 Camp Bowie posterior thigh pain. This study describes a previously undocumented variation of the ST Boulevard, Fort Worth, Texas, 76107-2699, USA. origin that could predispose a patient to the aforementioned thigh pain, as well as pelvic floor pain. Patients presenting with recurrent pain or dysfunction in these areas should prompt an investigation into possible variations of hamstring muscle origins. Armando Rosales, MD © Int J Anat Var (IJAV). 2013; 6: 225–227. Department of Cell Biology & Anatomy University of North Texas Health Science Center 3500 Camp Bowie Boulevard Fort Worth, TX 76107-2699, USA. +1 (817) 735-2032 [email protected] Received February 26th, 2013; accepted August 22nd, 2013 Key words [semitendinosus] [variation] [strain] [hamstring] [muscle] Introduction 2).
    [Show full text]
  • Chapter 9 the Hip Joint and Pelvic Girdle
    The Hip Joint and Pelvic Girdle • Hip joint (acetabular femoral) – relatively stable due to • bony architecture Chapter 9 • strong ligaments • large supportive muscles The Hip Joint and Pelvic Girdle – functions in weight bearing & locomotion • enhanced significantly by its wide range of Manual of Structural Kinesiology motion • ability to run, cross-over cut, side-step cut, R.T. Floyd, EdD, ATC, CSCS jump, & many other directional changes © 2007 McGraw-Hill Higher Education. All rights reserved. 9-1 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-2 Bones Bones • Ball & socket joint – Sacrum – Head of femur connecting • extension of spinal column with acetabulum of pelvic with 5 fused vertebrae girdle • extending inferiorly is the coccyx – Pelvic girdle • Pelvic bone - divided into 3 • right & left pelvic bone areas joined together posteriorly by sacrum – Upper two fifths = ilium • pelvic bones are ilium, – Posterior & lower two fifths = ischium, & pubis ischium – Femur – Anterior & lower one fifth = pubis • longest bone in body © 2007 McGraw-Hill Higher Education. All rights reserved. 9-3 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-4 Bones Bones • Bony landmarks • Bony landmarks – Anterior pelvis - origin – Lateral pelvis - for hip flexors origin for hip • tensor fasciae latae - abductors anterior iliac crest • gluteus medius & • sartorius - anterior minimus - just superior iliac spine below iliac crest • rectus femoris - anterior inferior iliac spine © 2007 McGraw-Hill Higher Education. All rights reserved. 9-5 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-6 1 Bones Bones • Bony landmarks • Bony landmarks – Medially - origin for – Posteriorly – origin for hip hip adductors extensors • adductor magnus, • gluteus maximus - adductor longus, posterior iliac crest & adductor brevis, posterior sacrum & coccyx pectineus, & gracilis - – Posteroinferiorly - origin pubis & its inferior for hip extensors ramus • hamstrings - ischial tuberosity © 2007 McGraw-Hill Higher Education.
    [Show full text]
  • Gluteal Region and Back of the Thigh Anatomy Team 434
    Gluteal Region and Back of the Thigh Anatomy Team 434 Color Index: If you have any complaint or ▪ Important Points suggestion please don’t ▪ Helping notes hesitate to contact us on: [email protected] ▪ Explanation OBJECTIVES ● Contents of gluteal region: ● Groups of Glutei muscles and small muscles (Lateral Rotators). ● Nerves & vessels. ● Foramina and structures passing through them as: 1-Greater Sciatic Foramen. 2-Lesser Sciatic Foramen. ● Back of thigh : Hamstring muscles. CONTENTS OF GLUTEAL REGION Muscles 1- Gluteui muscles (3): • Gluteus maximus. (extensor) • Gluteus minimus. (abductor) • Gluteus medius. (abductor) 2- Group of small muscles (lateral rotators) (5): from superior to inferior: • Piriformis. • Superior gemellus. • Obturator internus. • Inferior gemellus. • Quadratus femoris. CONTENTS OF GLUTEAL REGION (CONT.) Nerves (all from SACRAL PLEXUS): • Sciatic N. • Superior gluteal N. • Inferior gluteal N. • Posterior cutaneous N. of thigh. • N. to obturator internus. • N. to quadratus Vessels femoris. (all from INTERNAL ILIAC • Pudendal N. VESSELS): 1. Superior gluteal 2. Inferior gluteal 3. Internal pudendal vessels. Sciatic nerve is the largest nerve in the body. Greater sciatic foramen Structures passing through Greater foramen: Greater & lesser sciatic notch of -hippiriformis bone are muscle. transformed into foramen by sacrotuberous & Abovesacrospinous piriformis ligaments. M.: -superior gluteal nerve & vessels. Below piriformis M.: -inferior gluteal nerves & vessels. -sciatic N. -nerve to quadratus femoris. -posterior cutaneous nerve of thigh. -internal pudendal vessels Found in the -nerve to obturator internus. lesser sciatic foramen -pudendal N. Lesser sciatic foramen Structures passing through Lesser sciatic foramen: -internal pudendal vessels -nerve to obturator internus. -pudendal N. -tendon of obturator internus. Glutei Muscles (origins) Origin of glutei muscles: • gluteus minimus: Anterior part of the gluteal surface of ilium.
    [Show full text]
  • Biceps Femoris Muscle Is Activated by Performing Nordic Hamstring Exercise at a Shallow Knee Flexion Angle
    ©Journal of Sports Science and Medicine (2021) 20, 275-283 http://www.jssm.org DOI: https://doi.org/10.52082/jssm.2021.275 ` Research article Biceps Femoris Muscle is Activated by Performing Nordic Hamstring Exercise at a Shallow Knee Flexion Angle Norikazu Hirose 1, Masaaki Tsuruike 2 and Ayako Higashihara 3 1 Faculty of Sport Sciences, Waseda University, Tokyo, Japan; 2 Department of Kinesiology, San José State University, CA, USA; 3 Institute of Physical Education, Keio University, Kanagawa, Japan phase (Higashihara et al., 2018). In addition to its high Abstract muscular work rate, the length of the BFlh muscle peaks The semitendinosus (ST) muscle is primarily used during Nordic during the late swing phase and develops maximal force hamstring exercise (NHE), which is often prescribed for prevent- while undergoing a forceful eccentric contraction to decel- ing hamstring injury, though the biceps femoris long head (BFlh) erate the shank for the foot strike (Chumanov et al., 2011). muscle that is more susceptible to injuries. Thus, this study aimed These BFlh muscle dynamics during sprinting are thought to identify the modulation of BFlh muscle activity with different to represent the possible mechanism of HSI. knee flexion angles during NHE using an inclined platform. Four- teen male athletes performed NHE and maintained their position The key concept for preventing sprint-type HSI has at maximum inclination (NH). Subjects also performed isometric been the development of eccentric strength contractions in NHE using a platform inclined to 50° (ICL) and 40° (ICH), and hamstring muscles (Petersen et al., 2011; Opar et al., 2015; the knee flexion angle was controlled to 50° and 30°.
    [Show full text]
  • Download PDF File
    Folia Morphol. Vol. 77, No. 1, pp. 138–143 DOI: 10.5603/FM.a2017.0069 O R I G I N A L A R T I C L E Copyright © 2018 Via Medica ISSN 0015–5659 www.fm.viamedica.pl Anatomy and morphometry of the distal gracilis muscle tendon in adults and foetuses D.W. Dziedzic, U. Bogacka, I. Komarniţki, B. Ciszek Department of Descriptive and Clinical Anatomy, Centre of Biostructure Research, Medical University of Warsaw, Poland [Received: 18 January 2017; Accepted: 27 April 2017] Ten human gracilis muscles obtained from adults and ten gracilis muscles col- lected from human foetuses between the 15th and 21st week of gestation were examined. The results of this preparatory study show that the gracilis muscle in adults is narrow and long — 482 mm on average. The distal tendon of gracilis muscle is long, 294 mm on average. It can be divided into two sections — external part, outside the muscle belly, and internal, intramuscular, part. The latter one is partially covered by muscle fibres and some of it is completely hidden inside the muscle belly, which is on average 76 mm long. Presence of an intramuscular part of the distal tendon was also demonstrated in the foetal material. Moreover, very strong correlations between particular muscle lengths were noted in foetuses. (Folia Morphol 2018; 77, 1: 138–143) Key words: gracilis, pes anserinus, foetal muscle, tendon INTRODUCTION Several accessory bundles, usually 3–5, may The gracilis muscle is located on the medial side emerge from the tendon at the distal end. They may of the thigh.
    [Show full text]
  • Back of Thigh
    Hamstring muscles The word ham originally referred to the fat and muscle behind the knee. String refers to tendons, and thus, the hamstrings are the string- like tendons felt on either side of the back of the knee. THE ADDUCTOR MAGNUS Adductor magnus Adductor part: inferior ramus of pubis, ramus of ischium Hamstrings part: ischial tuberosity Adductor part: gluteal tuberosity, linea aspera, medial supracondylar line Hamstrings part: adductor tubercle of femur Adductor part: obturator nerve (L2, L3, L4), branches of posterior division Hamstrings part: tibial part of sciatic nerve (L4) Adducts thigh Adductor part: flexes thigh Hamstrings part: extends thigh THE BICEPS FEMORIS MUSCLE Long head: ischial tuberosity Short head: linea aspera and lateral supracondylar line of femur Lateral side of head of fibula; tendon is split at this site by fibular collateral ligament of knee Long head: tibial division of sciatic nerve (L5, S1, S2) Short head: common peroneal division of sciatic nerve (L5, S1, S2) Flexes leg and rotates it laterally when knee is flexed; extends thigh (e.g., when starting to walk) THE SEMITENDINOSUS MUSCLE Ischial tuberosity Medial surface of superior part of tibia Tibial division of sciatic nerve (L5, S1, S2) Extend thigh; flex leg and rotate it medially when knee is flexed; when thigh and leg are flexed, these muscles can extend trunk THE SEMIMEMBRANOSUS MUSCLE Ischial tuberosity Posterior part of medial condyle of tibia; reflected attachment forms oblique popliteal ligament (to lateral femoral condyle) Tibial division of
    [Show full text]
  • The Origins of the Hamstring Muscles B
    J. Anat. (1968), 102, 2, pp. 345-352 345 With 11 figures Printed in Great Britain The origins of the hamstring muscles B. F. MARTIN Department of Human Biology and Anatomy, University of Sheffield From reference to standard works (e.g. Macalister, 1889; Thane, 1894; Rouviere, 1912; Wilde, 1949; Grant & Smith, 1953; Hollinshead, 1958; Last, 1959; Davies & Davies, 1962; Romanes, 1964; Grant, 1965) it is by no means clear how the tendons- of the hamstring muscles are related to one another at their origins or how they attain their relative positions just beyond their places of origin. Of this group the semimembranosus is particularly difficult to understand, and part of the difficulty is due to incorrect appraisal of the position of the facets on the ischial tuberosity, from which the hamstrings largely arise. The ischial tuberosity The tuberosity is divisible into an upper region, which bears two smooth facets. and a lower region which is roughened. Both regions are related to the hamstring origins. Although a few authors describe the facets simply as medial and lateral in position (e.g. Macalister; Rouviere; Hollinshead), the majority describe and illustrate the region as divided by an oblique ridge into a lower and medial and an upper and lateral facet (e.g. Thane; Wilde; Romanes; Davies & Davies; Grant; Terry & Trotter, 1953; Breathnach, 1965). If the facets did have this arrangement, it would be hard to imagine how the semimembranosus, which arises from the lateral facet, could gain the deep aspect of the biceps and semitendinosus, the common tendon of which arises from the medial facet.
    [Show full text]
  • Third Head of Biceps Femoris Muscle-A Case Report
    International Surgery Journal Ghatak S et al. Int Surg J. 2021 Apr;8(4):1343-1346 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: https://dx.doi.org/10.18203/2349-2902.isj20211322 Case Report Third head of biceps femoris muscle-a case report Surajit Ghatak, Sonali Adole, Debajani Deka*, Muhamed Faizal Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Received: 21 January 2021 Revised: 26 February 2021 Accepted: 04 March 2021 *Correspondence: Dr. Debajani Deka, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Sometimes variations in biceps femoris may be noticed like an accessory head of biceps femoris. Here during routine cadaveric dissection in the department of anatomy. All India institute of medical sciences, Jodhpur we found a case with an accessory head of biceps femoris in both the lower limbs. The muscle belly is originating from the fibers of long head of biceps femoris and going downward medially to get inserted to the medial condyle of tibia on its medial superior aspect. On the right-side insertion site is like a sheath and on half a way it is merging with medial intermuscular septum of thigh. On the left side insertion is first like a thin sheath and then a thin muscle belly. The muscle belly is thin as compared to the long and short head of the main muscle bellies.
    [Show full text]
  • The Hamstring Muscle Complex
    Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-013-2744-0 SPORTS MEDICINE The hamstring muscle complex A. D. van der Made • T. Wieldraaijer • G. M. Kerkhoffs • R. P. Kleipool • L. Engebretsen • C. N. van Dijk • P. Golano´ Received: 19 April 2013 / Accepted: 22 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract better understanding of the hamstring injury pattern. These Purpose The anatomical appearance of the hamstring include overlapping proximal and distal tendons of both the muscle complex was studied to provide hypotheses for the long head of the biceps femoris muscle and the semi- hamstring injury pattern and to provide reference values of membranosus muscle (SM), a twist in the proximal SM origin dimensions, muscle length, tendon length, muscu- tendon and a tendinous inscription (raphe) in the semiten- lotendinous junction (MTJ) length as well as width and dinosus muscle present in 96 % of specimens. length of a tendinous inscription in the semitendinosus Conclusion No obvious hypothesis can be provided muscle known as the raphe. purely based on either muscle length, tendon length or MTJ Methods Fifty-six hamstring muscle groups were dis- length. However, it is possible that overlapping proximal sected in prone position from 29 human cadaveric speci- and distal tendons as well as muscle architecture leading to mens with a median age of 71.5 (range 45–98). a resultant force not in line with the tendon predispose to Results Data pertaining to origin dimensions, muscle muscle injury, whereas the presence of a raphe might plays length, tendon length, MTJ length and length as well as a role in protecting the muscle against gross injury.
    [Show full text]
  • Ultrasound Features of the Proximal Hamstring Muscle‐Tendon
    PICTORIAL ESSAY Ultrasound Features of the Proximal Hamstring Muscle-Tendon-Bone Unit Marco Becciolini, MD , Giovanni Bonacchi, MD, Stefano Bianchi, MD The hamstring muscle complex is made by a group of posterior biarticular thigh muscles, originating at the ischial tuberosity, which extend the hip and flex the knee joint. Proximal hamstring injuries are frequent among athletes, commonly involving their long myotendinous junction during an eccentric contraction. In this pictorial essay, we describe the ultrasound technique to visualize the normal anatomy of the proximal hamstring muscle-tendon-bone complex and present ultrasound findings in patients with traumatic injuries and tendinopathies. Key Words—athlete injury; biceps femoris; hamstring; musculoskeletal; myotendinous injury; tendinopathy; thigh muscles; ultrasound he hamstring muscle complex comprises a group of posterior biarticular thigh muscles, originating at the ischial tuberosity: the long head of the biceps femoris, semimembranosus, and T 1 semitendinosus. These muscles extend the hip and flex the knee joint. Proximal hamstring muscle complex injuries are the most frequent among athletes, commonly involving the proximal myotendinous junction during an eccentric contraction.2,3 So far, magnetic resonance imaging (MRI) has been considered as the modality of choice to – evaluate tendinopathy and injuries.3 6 In this pictorial essay, our aims are to describe the ultrasound (US) technique for visualizing the proximal hamstring muscle complex and to illustrate US findings in patients with traumatic injuries and tendinopathies. This human study was performed in accordance with the Dec- laration of Helsinki. The study was approved by the Cabinet Ima- gerie Médicale. All parents, guardians, or next of kin provided written informed consent for the minors to participate in the study.
    [Show full text]
  • Sonographic Landmarks in Hamstring Muscles
    Skeletal Radiology https://doi.org/10.1007/s00256-019-03208-x REVIEW ARTICLE Sonographic landmarks in hamstring muscles Ramon Balius1,2 & Carles Pedret2,3 & Iñigo Iriarte4 & Rubén Sáiz4 & Luis Cerezal5 Received: 30 July 2018 /Revised: 27 February 2019 /Accepted: 11 March 2019 # The Author(s) 2019 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. Therefore, it is important to know the specific ultrasound reference points that facilitate the location of the hamstring structures, dividing them into four areas of interest: (a) tendinous origin of the hamstring, (b) the proximal half, (c) distal and medial half, and (d) distal and lateral half. The origin of the hamstrings is found at the level of the ischial tuberosity. Here, the connective structures under study are the common tendon and the semimembranosus tendon, together with the muscle fibers more proximal to the semitendinosus, which can also be assessed through ultrasound locating the ischial tuberosity. The proximal half of the thigh consists of a characteristic structure made up by the common tendon, the sciatic nerve and the semimembranosus tendon, enabling to define the biceps femoris and the semitendinosus, respectively. To identify the distal and medial section, the volumetric relationship between the ST and SM muscle masses is used, where it is also possible to identify the three muscles in the knee that make up the pes anserine. To identify the distal and lateral sections, the sciatic nerve pathway is followed until identifying both heads of the biceps femoris.
    [Show full text]