Anatomy: The large posterior thigh muscles (hamstring muscles) have a common muscle tendon fastening on the ischiatic bone (tuber ischii). Below the tendon fastening there is a bursa which reduces the load on the tendon when the tendon slides against the bone. The posterior thigh muscles flex the knee and stretch the hip.

Symptoms: Pain upon applying pressure on the bursa (sitting position), which sometimes (but far from always) may feel swollen. Aggravated upon stretching and activation of the posterior thigh muscles (flexing of the knee against resistance) (article).

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness, medical examination is not necessarily required. In cases of more pronounced pain or lack of progress, a medical examination should be carried out to ensure a correct diagnosis and commencement of treatment. The diagnosis is usually made on the basis of a normal medical examination, however, if there is any doubt surrounding the diagnosis, it can easily and quickly be confirmed under an ultrasound scan.

Treatment: The treatment primarily consists of relief. The treatment can be supplemented with rheumatic medicine (NSAID) or the injection of corticosteroid in the bursa preceded by draining of the bursa, which can advantageously be done under ultrasound guidance.

Complications: If progress is not smooth, it should be considered if the diagnosis is correct or whether complications have arisen. The following should in particular be considered:

• Tendinitis at the ischiatic bone
• Muscle rupture of the tendon fastening on the ischiatic bone
• Piriformis syndrome
• Degenerative arthritis in the hip joint
• Rupture of the deep hip flexor (M iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the hip joint
• Complications of muscle ruptures
• Lumbago
• Slipped disc