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 recognised source of pain in the buttock and upper thigh, particularly in individuals who take part in activities that involve repetitive hip flexion and extension, such as running, sprinting, and cycling.

Although frequently seen in athletes, this condition is not limited to them. It may also affect individuals who sit for prolonged periods or those who perform repetitive movements as part of their work or daily activities. Symptoms can interfere with sport, exercise, and routine tasks such as sitting comfortably or bending forwards.

At Alton Pain Clinic, clinicians provide ultrasound guided cortisone injections as one of the interventional options to support individuals with proximal hamstring tendinopathy. Ultrasound allows precise visualisation of the affected tendon and surrounding structures, ensuring accurate placement of the injection.

Anatomy of the Hamstrings and Pelvis

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

  • Biceps femoris
  • Semimembranosus
  • Semitendinosus

They arise from the ischial tuberosity, commonly referred to as the “sitting bone,” and extend down the thigh to attach below the knee joint. The proximal tendons are the tough fibrous structures that anchor the muscles to the pelvis.

These muscles play key roles in:

  • Hip extension: Moving the thigh backwards during walking, running, or climbing.
  • Knee flexion: Bending the knee.

The tendons lie close to the sciatic nerve, which runs through the buttock and down the leg. This proximity can make symptoms of proximal hamstring tendinopathy sometimes overlap with sciatic-type pain.

Pathology of Proximal Hamstring Tendinopathy

This condition is characterised by microscopic degeneration and disorganisation within the tendon tissue at its origin. It is less about acute inflammation and more about structural change due to overuse or repeated stress.

Features include:

  • Collagen fibre disruption.
  • Thickening of the tendon.
  • Abnormal blood vessel growth within the tendon.
  • Microscopic tears.

These changes are thought to result from the tendon’s inability to adapt to repeated or excessive mechanical loading.

Causes and Risk Factors

Factors that may contribute include:

  • Repetitive strain from sports like running, sprinting, or kicking.
  • Prolonged sitting on hard surfaces.
  • Sudden increases in training load.
  • Previous hamstring injuries.
  • Poor biomechanics or pelvic instability.
  • Age-related tendon changes.

Symptoms

Common symptoms are:

  • Deep buttock pain near the sit bone.
  • Pain during running, sprinting, or prolonged sitting.
  • Discomfort when bending forwards with the knee straight.
  • Tenderness over the ischial tuberosity.
  • Tightness and stiffness in the hamstrings.

Pain may range from a dull ache to sharper discomfort and can limit both sport and daily life activities.

Diagnosis

Diagnosis is made through a detailed history and examination by a clinician.

  • Examination: Palpation of the ischial tuberosity, resisted hip extension tests, and hamstring flexibility assessments.
  • Imaging: Ultrasound can show tendon thickening, degeneration, or partial tearing.

It is important to distinguish this condition from others such as lumbar spine issues, piriformis syndrome, or sacroiliac joint dysfunction.

Management Options

Approaches may include:

  • Activity modification.
  • Ultrasound guided injections

Ultrasound Guided Cortisone Injections

At Alton Pain Clinic, ultrasound guided cortisone injections are one option available for proximal hamstring tendinopathy. The use of ultrasound ensures accuracy in directing the medicine to the affected tendon origin.

Benefits of Ultrasound Guidance

  • Direct visualisation of the tendon.
  • Accurate delivery of the injection.
  • Reduced likelihood of affecting nearby structures such as the sciatic nerve.

Cortisone and Its Mechanism of Action

Cortisone is a corticosteroid medicine with strong anti-inflammatory properties.

When delivered precisely to the tendon area, cortisone may:

  • Reduce local irritation.
  • Ease swelling and tissue stress.
  • Improve comfort in movement.

The injection may also serve a diagnostic role, as improvement in symptoms following the injection can help confirm the tendon as the primary source of pain.

Why Choose Alton Pain Clinic

  • Expert clinicians experienced in musculoskeletal conditions and image-guided techniques.
  • Personalised care tailored to each individual.
  • High-resolution ultrasound technology for precise treatment delivery.

Conclusion

Proximal hamstring tendinopathy is a condition that can interfere with both athletic and everyday activities. By understanding its anatomy, pathology, and symptoms, clinicians can help guide management appropriately.

At Alton Pain Clinic, ultrasound guided cortisone injections are one of the interventional options offered to support individuals with this condition. The focus is on accuracy, comfort, and tailored care.

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