The Pop Of Pickleball

HISTORY: A 67-year-old female presents to the sports medicine office for evaluation of left thigh injury. The injury occurred three weeks prior while the patient was out of state playing pickleball. She felt that her left hip “went out” and then experienced significant weakness with sit to stand maneuver and weakness with activities of daily living. She was seen by her primary care provider who recommended physical therapy and referred her to the sports medicine office. Pain is aching in nature, moderate to severe in severity, and exacerbated with direct pressure such as touch or while seated. The pain is located near the ischial tuberosity with some “burning” pain that radiates down the posterior leg and overall, has improved since initial injury. Significant bruising has appeared over the posterior left thigh. PHYSICAL EXAMINATION: Musculoskeletal exam reveals 2/5 strength with knee flexion on the left, 5/5 on the right. She has difficulty initiating knee flexion on the left. There is a palpable defect with knee flexion on the left side and there is tenderness to palpation at the ischial tuberosity. Full active ROM and strength of the bilateral hips in abduction, adduction, flexion, and extension. No tenderness to palpation of the greater trochanter or pubic symphysis. DIFFERENTIAL DIAGNOSIS: 1. Avulsion fracture of the ischial tuberosity 2. Adductor injury3. Hamstring injury4. Lumbar disc herniation TEST AND RESULTS: MRI Left Thigh: 1. Complete tear of the left hamstring tendon complex with distal retraction. 2. Hematoma anterior to the distally retracted tendon complex; retraction measuring up to 13.7 cm 3. Tendinosis of the right hamstring tendon complex 4. Patellofemoral Compartment osteoarthritis FINAL WORKING DIAGNOSIS: Complete tear of the hamstring tendon complex TREATMENT AND OUTCOMES: Patient has been referred to orthopedic surgery for surgical evaluation and is to undergo hamstring reconstruction with possible autografting.