Ultrasound Guided Cortisone Injection for Proximal Hamstring Tendinopathy

 

Introduction

Proximal Hamstring Tendinopathy (PHT) is a condition that affects the hamstring tendons where they attach to the ischial tuberosity at the base of the pelvis. It is a relatively common source of pain in the buttock and upper thigh, especially among individuals involved in activities requiring repetitive hip flexion and extension, such as running, sprinting, and cycling.

Although often associated with athletes, proximal hamstring tendinopathy can also affect individuals who sit for prolonged periods or perform repetitive movements in daily life. The condition can interfere with physical activity, sport participation, and even routine tasks such as sitting comfortably or bending forwards.

At Joint Injections, clinicians provide ultrasound guided cortisone injections as one of the interventional options to support individuals with symptoms related to proximal hamstring tendinopathy. Ultrasound guidance allows for precision and accuracy in the placement of the injection, ensuring it is directed to the affected area.

This blog will cover the anatomy, pathology, causes, symptoms, diagnosis, management, and the role of ultrasound guided cortisone injections for proximal hamstring tendinopathy.

Anatomy of the Hamstrings and Pelvis

The hamstrings are a group of three muscles located at the back of the thigh:

  • Biceps femoris
  • Semimembranosus
  • Semitendinosus

These muscles originate from the ischial tuberosity (the “sitting bone” at the base of the pelvis) and extend down the back of the thigh to attach below the knee joint. The proximal (upper) tendons are the strong fibrous structures connecting the hamstrings to the pelvis.

The hamstrings are responsible for two main functions:

  • Hip extension: Moving the thigh backwards, essential in walking, running, and climbing.
  • Knee flexion: Bending the knee.

The tendons at the top of the hamstrings are positioned close to the sciatic nerve, which runs through the buttock and down the back of the leg. This anatomical proximity can sometimes complicate the symptoms and presentation of proximal hamstring tendinopathy.

Pathology of Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy is characterised by degeneration, microtearing, and structural changes in the tendon tissue where it attaches to the ischial tuberosity.

Key pathological features include:

  • Collagen disorganisation: Healthy tendon fibres are aligned in a parallel structure, but in tendinopathy, the fibres may become disrupted.
  • Thickening of the tendon: The tendon may enlarge in response to repeated stress.
  • Increased vascularity: Small blood vessels may grow into the tendon, which is not typical of healthy tendon tissue.
  • Microscopic tears: Repeated overload can create small tears within the tendon.

This degenerative process is often described as a failure of the tendon to adapt to repetitive mechanical loading, particularly in activities that involve running, sprinting, or sitting on hard surfaces for extended periods.

Causes and Risk Factors

Several factors may contribute to the development of proximal hamstring tendinopathy, including:

  • Repetitive strain: Overuse through running, sprinting, or kicking.
  • Prolonged sitting: Sitting on firm surfaces for long durations can irritate the tendon insertion.
  • Sudden increase in activity: A rapid rise in training intensity or volume.
  • Previous hamstring injuries: Prior tears or strains may predispose the tendon to tendinopathy.
  • Poor biomechanics: Weakness in surrounding muscles or altered pelvic alignment.
  • Age-related changes: Tendons lose elasticity and strength with age, making them more vulnerable.

Symptoms of Proximal Hamstring Tendinopathy

Typical symptoms include:

  • Deep buttock pain, often close to the sit bone.
  • Pain that worsens during activities such as running, sprinting, or prolonged sitting.
  • Discomfort when bending forwards, especially with the knee extended.
  • Localised tenderness over the ischial tuberosity.
  • Stiffness and tightness in the hamstrings.

The pain can range from mild to severe and may interfere with both sporting activities and daily tasks.

Diagnosis

Diagnosis of proximal hamstring tendinopathy usually involves a detailed history and clinical examination by a clinician.

  • Physical examination: May include palpation of the ischial tuberosity, functional tests such as resisted hip extension, and assessment of hamstring flexibility.
  • Imaging: Ultrasound may be used to visualise tendon thickening, partial tears, or degenerative changes.

Accurate diagnosis is essential to differentiate proximal hamstring tendinopathy from other causes of buttock pain, such as lumbar spine problems, piriformis syndrome, or sacroiliac joint dysfunction.

Management of Proximal Hamstring Tendinopathy

Management is typically multi-faceted and may involve:

  • Activity modification: Reducing activities that aggravate symptoms.
  • Injections: Ultrasound guided injections such as cortisone may be considered in selected cases.

Ultrasound Guided Cortisone Injections

At Joint Injections, clinicians use ultrasound imaging to guide cortisone injections for proximal hamstring tendinopathy. Ultrasound guidance ensures the needle is placed accurately at the tendon origin, allowing for precise delivery.

Advantages of Ultrasound Guidance

  • Clear visualisation of the tendon and surrounding structures.
  • Precise targeting of the affected area.
  • Reduced risk of affecting nearby structures such as the sciatic nerve.

Cortisone and Its Mechanism of Action

Cortisone is a type of corticosteroid medicine that acts as a potent anti-inflammatory.

When delivered into the area of tendon irritation, cortisone may:

  • Reduce local inflammation.
  • Decrease swelling around the tendon.
  • Calm down irritation in adjacent soft tissues.
  • Support more comfortable movement.

The injection itself may also have a diagnostic role, as symptom improvement following the procedure can confirm the tendon as the primary source of pain.

Why Choose Joint Injections

At Joint Injections, the use of ultrasound guidance allows clinicians to deliver injections with accuracy and care. The focus is on precision, patient comfort, and tailoring the approach to each individual.

Conclusion

Proximal hamstring tendinopathy can be a difficult condition that interferes with sport, exercise, and everyday life. With an understanding of the anatomy, pathology, and symptoms, combined with careful diagnostic assessment, management can be tailored to individual needs.

At Joint Injections, clinicians provide ultrasound guided cortisone injections as one of the options available for proximal hamstring tendinopathy, ensuring accuracy and precision in care.

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