Hamstrings Origin Injection

Chronic tendinitis or acute or chronic ischial bursitis

Causes and findings:
• Overuse - such as prolonged riding on horse or bicycle, or running
• Trauma - fall onto buttock, or sudden acceleration, kicking
• Pain in buttock
• Painful: resisted extension passive straight leg raise
• Very tender over ischial tuberosity

Equipment:
Syringe - 2ml
Needle - 21G 2 inches (50mm) green
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml

Anatomy:
The hamstrings have a common origin arising from the ischial tuberosity. The tendon is approximately three fingers wide here. The ischial bursa lies between the gluteus maximus and the bone of the ischial tuberosity.

Technique:
• Patient lies on unaffected side with lower leg straight and upper leg flexed
• Identify ischial tuberosity and mark tendon lying immediately distal
• Insert needle into mid-point of tendon and angle up toward tuberosity to touch bone
• Pepper solution into teno-osseous junction of tendon or inject as bolus into bursa

Aftercare:
Avoidance of precipitating activities such as sitting on hard surfaces or prolonged running is maintained for at least a week and then graduated stretching and strengthening programme is started.

Comments:
Tendinitis and bursitis can occur together at this site, in which case a larger volume is drawn up and both lesions infiltrated. As usual, it is difficult to differentiate between the two lesions, but if there is a history of a fall or friction overuse and extreme tenderness at the tuberosity, bursitis is suspected. Occasionally, haemorrhagic bursitis can occur as a result of a hard fall. Aspiration of the blood is then performed prior to infiltration.