Pérez-Bellmunt A.1,2,3, Miguel M.3,4, Blasi M.3,4, Blasi J.4, Pérez C.5, Ortiz S.3, Martinoli C.6, Kuisma R.7
1Universitat Internacional de Catalunya, Basic Sciences, Barcelona, Spain, 2SARX (Research Group in the Anthropology of Corporality), Barcelona, Spain, 3Human Anatomy and MSK Ultrasound Lab, Barcelona, Spain, 4Universitat de Barcelona, Barcelna, Spain, 5Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa. Universitat de Barcelona, Terrassa, Spain, 6Universita di Genova, Genova, Italy, 7University of Brighton, Eastbourne, United Kingdom
Background: Hamstring muscles strain is one of the most common injuries during the sport practice. It may affects any of the components of the muscle group but the proximal attachment of hamstring is the site most frequently injured and the biceps femoris is consistently the most commonly injured of the three muscles.
A multifactorial etiology has been proposed based on the biomechanics and morphology of the proximal attachment of hamstring muscles, but the evidences are often inconclusive or contradictory. Some studies have suggested that the biceps femoris muscle is predisposed to injury due to its myofascial attachments.
A multifactorial etiology has been proposed based on the biomechanics and morphology of the proximal attachment of hamstring muscles, but the evidences are often inconclusive or contradictory. Some studies have suggested that the biceps femoris muscle is predisposed to injury due to its myofascial attachments.
Purpose: The aim of this study was to describe the anatomy, the histology and ultrasonography of the fascia surrounding the proximal attachment of the hamstring muscles.
Methods: In 66 cryopreserved lower limbs were studied the fascial tissue surrounding the proximal attachment of hamstring muscles by dissection and anatomical sections, histology (hematoxylin-eosin and fluorescence microscopy) and ultrasound images.
The body donor program of the Faculty of Medicine (Bellvitge Science Heath Campus), University of Barcelona, provided all specimens.
Results: All specimens studied presented an annular connective tissue structure that resembles a retinaculum, which covered and adapted to the attachment of hamstring muscles on the ischial tuberosity. Also in this level, this fascial structure covered the sciatic nerve and the posterior femoral cutaneous nerve. Superficially, the fascial retinaculum received loose connective tissue expansions from the epimysium of the gluteus maximus, which was uncovered when placing its muscle aside. The histological results showed that the deep lateral aspect of the retinaculum adhered tightly to the superior and lateral aspects of the long head of the proximal biceps femoris epitenon and there was a layer of connective tissue between the deep medial aspect of the retinaculum and the epimysium of the semitendinosus. The ultrasound images also exposed the presence of this fascial structure surrounding the proximal attachment of hamstring muscles and its relation with the sciatic and posterior femoral cutaneous nerves.
Conclusion(s): This study revealed how this retinaculum was continuous with the long head of biceps femoris muscle, however there was a layer of loose connective tissue between the retinaculum and the semitendinosus muscle. Furthermore, this structure had a fascial relation with the sciatic nerve and posterior cutaneous nerve.
Implications: The present study identifies a potential local structure which may be important in hamstring injuries or the neuropathy of sciatic nerve and may be addressed through the application of manual therapy.
Funding acknowledgements: None
Topic: Musculoskeletal
Ethics approval: Research Ethics Committee from Universitat Internacional de Catalunya (UIC-Barcelona)
All authors, affiliations and abstracts have been published as submitted.
