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What is the Vitamin B12 Injection? The Vitamin B12 injection is an effective way to treat a B12 deficiency. There is only one type of vitamin B12 injection available in the UK

Epidemiology Incidence make up 30% of new lower extremity injuries in athletes annual increase of 4% noted in soccer players over last ~15 years Demographics most commonly seen in rapid acceleration sports soccer, track and field, and football Anatomic location is the most common site of rupture in adults often occurs during sprinting avulsion of ischial tuberosity less common seen in skeletally immature seen in water skiers Risk factors previous hamstring injury (increases risk of reinjury by factor of 6) previous injury leads to formation of weakened scar tissue lowering threshold to recurrent injury inadequate warm-up strength imbalance (hamstring to quadriceps ratio 10-15%) reduced hip extension leg-length differences (shorter leg has tighter hamstrings) Etiology Pathophysiology Mechanism of injury intramuscular and musculotendinous injuries proximal hamstring avulsions Pathobiology satellite cell plays a role in muscle healing following muscle injury Anatomy 4 muscles biceps femoris origin all originate on ischial tuberosity except short head insertion semimembranosus inserts on posterior aspect of medial tibial condyle semitendinosus inserts on superomedial tibial shaft within the pes anserine biceps femoris long head inserts on fibular head biceps femoris short head has many insertions (fibular head, biceps femoris long head, lateral knee capsule) innervation tibial branch of sciatic nerve: semimembranosus, semitendinosus, long head of biceps femoris common peroneal branch of sciatic nerve: short head of biceps femoris blood supply inferior gluteal artery and profunda femoral artery other hamstring origin on ischial tuberosity is ~6 cm proximal to inferior border of overlying gluteus maximus sciatic nerve is 1.2 cm from lateral bony aspect of hamstring origin pudendal nerve is 2-3cm superior-medial to the ischial tuberosity Biomechanics cross and act upon 2 joints: the hip and knee except short head which only crosses the knee joint Classification Presentation History sudden pain in the posterior thigh during running, kicking or jumping activity occasionally a "pop" felt Symptoms common symptoms posterior thigh pain hamstring tightness pain with sitting Physical exam inspection ecchymosis in posterior thigh palpation may have palpable mass in middle 1/3 of posterior thigh (myotendinous rupture) tenderness to palpation gait "stiff-legged" gait (avoiding knee and hip flexion) motion increased popliteal angle motor weak hamstring strength neurovascular may have peroneal nerve weakness (foot drop etc.) provocative tests the following tests are positive for hamstring tendinopathy or strain if the patient feels pain Imaging Radiographs recommended views AP pelvis, AP and lateral femur findings may show bony avulsion off of ischial tuberosity MRI indications evaluation of the insertion site and quantify number of involved tendons and degree of tendon retraction evaluate the sciatic nerve location (in chronic cases) findings may show avulsion off ischial tuberosity tendinopathy will be seen as increased signal intensity in T1-weighted images partial tears will have increased signal intensity on T2-weighted images Diagnosis Clinical and MRI diagnosis confirmed by history, physical exam, and MRI Treatment Nonoperative rest, ice, NSAIDS, protected weightbearing for 4 weeks followed by stretching and strengthening indications outcomes PRP injection indications outcomes Operative tendon repair indications outcomes indications outcomes Techniques rest, ice, NSAIDS, protected weightbearing for 4 weeks followed by stretching and strengthening modalities that have shown benefit massage, ultrasound, electrical stimulation protected weightbearing most studies state 4 weeks, but should be extended if patient still significantly symptomatic stretching and strengthening as symptoms resolve, abdominal, hip and quadriceps should be added to hamstring strengthening program to prevent reinjury hamstrings should be strengthened to correct any hamstring-quadriceps strength imbalance injury prevention Nordic hamstring exercise isolated targeting of specific hamstring muscles PRP injection recommendation is to administer within 24-48 hours of acute injury ultrasound-guided injection recommended tendon repair positioning prone with leg free so knee can be flexed to relieve hamstring tension

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