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It is tempting to read the Moen et al1 study and conclude that MRI is not very useful in assessing prognosis of hamstring strains. Previous studies have found a reasonable correlation between MRI severity and clinical outcome,2–4 but no previous study has compared such a multitude of clinical parameters with a similar number of MRI parameters head to head with a blinded methodology. That is the strength of Moen's study.
The clinical parameters proved to be at least as good as the MRI parameters and some were clearly superior. The best predictive MRI parameter found that injuries closer to the ischial tuberosity had a worse prognosis, but as a predictive variable it was almost identical to simply recording where tenderness started in relation to the ischial tuberosity on clinical assessment.1
When might MRI be useful?
With these MRI data, the authors are in a good position to conclude that MRI investigation is not justified for the average non-professional athlete suffering an average hamstring strain. The exception, though, is probably one of the types of hamstring injury excluded from this study—hamstring tendon rupture. If there is strong clinical suspicion of hamstring tendon rupture, for which surgery may …
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