Complete avulsion of the right proximal biceps femoris and semitendinosus with sciatic nerve palsy.
1) Athlete placed in a leg immobilizer, NWB on crutches.
2) Surgical reattachment and sciatic nerve decompression nine days after the injury.
3) Physical therapy.
Sensation improved three days following surgery. He regained full strength and flexibility seven months post-operatively. He was cleared for full activities seven months after the injury.
Later that month, he went on to win the prestigious "Iron Gator" award, an annual week-long strength competition between teammates in the weight room.
He subsequently transferred to another school and was lost to follow-up.
As this case illutrates, when evaluating a case of neuropraxia it is imperative to perform a thorough neurologic exam. Initial on-site evaluation begins with assessing airway, breathing and circulation (ABCs) followed by palpation of the cervical spine and then neurologic examination of the extremities.
When a case of neuropraxia is suspected or diagnosed, the differential diagnosis should include possible injuries to the affected nerve along its entire course, beginning at the spinal cord, progressing down to the main branches and then distal branches. Common sites of injury are at locations where the nerve undergoes tension, such as joints, or where the nerve is more superficially exposed. In this case, the injury occurred at the hip where the sciatic nerve exits the pelvis near the ischial tuberosity (the site of the biceps femoris avulsion).
1) Clark BB, Jaffe D, Henn RF and Lovering RM. "Evaluation and imaging of an untreated grade III hamstring tear: A case report". Clinical Orthopaedics and Related Research. 2011 Nov; 469(11):3248-52. E-published 2011 Aug 18.
2) Askling CM, Tengvar M, Saartok T and Thorstensson A. "Proximal hamstring strains of stretching type in different sports: injury situations, clinical and MRI characteristics, and return to sport". American Journal of Sports Medicine. 2008 Sep; 36(9):1799-804. E-published 2008 Apr 30.
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