Abstract

Hamstring syndrome is a gluteal sciatic pain, in which posttraumatic or congenital hard fibrotic bands irritate sciatic nerve at the insertion site of hamstring muscles to ischial tuberosity. Traction, mechanical compression and impingement of the sciatic nerve may occur in certain anatomopathological situations at the origin of the hamstrings on the ischial tuberosity. The symptoms include local pain at the ischial tuberosity irradiating to the posterior thigh which appears with the cyclic stress of running, after physical exercise, and typically during sitting. Hamstring syndrome diagnosis is basically done according to typical symptoms and finding. Differential diagnosis is required from piriformis syndrome, ischiogluteal bursitis, posterior femoral muscle compartment pain, scars in hamstring muscles and back originated symptoms. MRI is the best examination to detect abnormality at the ischial tuberosity area. The majority of the athletes with hamstring syndrome respond positively to conservative therapy but in the refractory cases the hamstring syndrome can be treated surgically by dividing the compressing band and by performing the sciatic neurolysis. This paper describes the results of the surgical treatment during the last 15 years of a personal series of 25 endurance athletes (middle and long distance running, marathon, triathlon, cycling) refractory to non operative treatments for a period of 1 to 6 years. Three bilateral operation have been made in different time; in two cases the operation has been performed after the failed piriformis surgery and in two cases was practised the miotomy of the hypertrofic quadratus femoris. Usually good results are seen in a few months after surgery, and all subjects returned to practice competitive sports except one patient with chronic lumbar back problems. The final healing may take 1/2 years in chronic cases. Hamstring syndrome is still misunderstood and it is often confused with other causes of sciatica despite its frequent occurrence in sports.