Sonographic assessment of hamstring injuries

Hamstring strain injuries are among the most common non‑contact muscle injuries in field and court sports, with high recurrence rates and substantial time loss. While MRI has long been the reference standard for grading, high resolution musculoskeletal ultrasound has become an indispensable adjunct, offering dynamic real‑time assessment, excellent depiction of superficial structures and lower cost.

Injury sub‑types are mapped to the British Athletics Muscle Injury Classifi cation, distinguishing myofascial, musculotendinous and intratendinous patterns, with particular emphasis on clinically important entities such as central intramuscular tendon and proximal conjoint tendon injuries, proximal origin/avulsion lesions and distal biceps femoris T‑junction strains.

Ultrasound features associated with prolonged return to play (RTP) and reinjury risk include larger lesion extent, tendinous involvement and persistent architectural defects or inflammatory changes on serial scans. While MRI remains superior for deep, subtle or complex proximal pathology, ultrasound is presented as a reliable, cost‑effective first‑line modality for most hamstring strains when performed with appropriate high end equipment and expertise.

A combined imaging strategy – early ultrasound for diagnosis and monitoring, with targeted MRI for high grade, proximal or equivocal cases – is advocated to optimise prognosis, rehabilitation planning and RTP decision making in both elite and recreational athletes.

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