distally direct scissors toward lateral malleolus inorder to keep instrument posterior to superficial peroneal nerve distally, avoid straying too medially so as too avoid injury to the dorsalis pedis proximally aim for the patella and distally to the center of the ankle inorder to ensure that the fasciotomy stays in anterior fascia is opened proximally & distally w/ long, blunt-pointed scissors blunt tipped scissors are used to spread above and below the fascia both proximally and distally after identifying septum, small nick is made in fascia of anterior intermuscular septum midway between the septum blunt tipped scissors are used to spread above and below the fascia on both sides of the intermuscular septum, both proximally tension is maintained on the fascia w/ a Kocher clamp attempt to identify the superficial peroneal nerve near the septum transverse incision is made over fascia of anterior & lateral compartments, which allows clear view of the intermuscular septum in the acute traumatic syndrome, a 15 cm incision is used in an elective chronic syndrome, a small 4-5 cm incision can be used incision is therefore placed over anterior intermuscular septum separating anterior & lateral compartments & Shaft, or alternatively placed halfway between the tibial crest and the fibula anterior & lateral compartments are approached thru single longitudinal incision placed halfway down leg 2 cm anterior to fibular Anterolateral Incision: (Two Incision Technique) Imaging of the hamstrings. Semin Musculoskelet Radiol. 2008 12:28–41.- Compartment Syndromes resulting from Tibial Fractures Practical management: hamstring muscle injuries. Clin J Sport Med. 2003 13:48–52.Ģ. Mann G, Shabat S, Friedman A, et al. Submission history: Submitted JRevised AugAccepted August 18, 2009įull text available through open access at Īddress for Correspondence: Jason Heiner, MD, Department of Emergency Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Ave, Fort Lewis, WA 98431Ĭonflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. Supervising Section Editor: Sean Henderson, MD 1, 2, 3 Appropriate referral for individualized rehabilitation may improve a patient’s functional outcome and an athlete’s ability to return to competition. 3 Most hamstring injuries should be acutely treated with rest, ice, compression, elevation, and nonsteroidal anti-inflammatories, but surgery may be indicated to reattach an avulsed fragment or to repair soft tissue ruptures of muscle or tendon. 3 Plain radiography may identify the crescent-shaped fragment of a proximal avulsion injury, and ultrasound or magnetic resonance imaging may delineate a macroscopic injury and help to guide therapy and predict prognosis. A functionally disabling third-degree strain is a complete rupture of the muscle-tendon unit that usually occurs as an avulsion injury from the ischial tuberosity. Second-degree strains represent a partial tear that may be accompanied by weakness and hematomas within and around the muscle. First-degree strains represent a stretching injury with microscopic damage. 1, 2 These injuries are classified by the degree of muscle strain. 1 Risk factors for injury include poor flexibility, inadequate warm-up, muscle imbalance and previous hamstring injury. The hamstring muscle complex of the posterior thigh extends from the ischial tuberosity of the pelvis to the proximal tibia and fibula and is the most commonly injured muscle group in sports involving running and sprinting. The pattern of ecchymoses seen over the patient’s posterior legs. Clinically, this patient had suffered a second-degree hamstring strain. A complete blood cell count, prothrombin time, and partial thromboplastin time were all normal. Both lower extremities had full range of motion, no loss of strength, a normal knee exam, and moderate distal hamstring tenderness without swelling or palpable soft tissue defects. He denied weakness, similar prior episodes, or bleeding abnormalities. Four days earlier he had the sudden onset of severe achy hamstring pain during a 50-yard sprint. Madigan Army Medical Center, Department of Emergency Medicine, Fort Lewis, WAĪ 48-year-old male presented to the emergency department with enlarging regions of ecchymoses over the posterior aspect of both legs (Figure 1).
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