Disclosures: Zainab Shirazi, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 68-year-old female presenting with several months of left posterior thigh pain.

Case Description or Program Description: Six months prior to presentation, she began experiencing pain in the left posterior thigh followed by inner thigh, hip flexor, and greater trochanter pain. She described symptoms as a pulling sensation felt in the back of her thigh, exacerbated by daily yoga practice. Alleviating factors included naproxen, heat, and topical lidocaine. On physical exam, there was no ecchymosis, misalignment, or gross deformity noted. She had tenderness to palpation over the greater trochanter and ischial tuberosity. Lower extremity strength was full and she was neurologically intact.

Setting: Outpatient Clinic

Assessment/Results: Musculoskeletal ultrasound (US) of the left posterior thigh demonstrated hypoechoic thickening of the semimembranosus and conjoint tendon attachments proximally with associated cortical irregularities on the ischial tuberosity, concerning for tendon rupture. Magnetic resonance imaging (MRI) revealed complete tear at the common origin of the conjoint tendon, high-grade tear at the origin of the semimembranosus tendon, and complete tear at the origin of the ischiocondylar portion of the adductor magnus with retraction. She elected to undergo an US-guided platelet-rich plasma (PRP) injection into the origin of the hamstring and adductor muscles followed by resumption of physical therapy two weeks after the procedure.

Discussion (relevance): Research supporting the efficacy of orthobiologics for musculoskeletal injuries has grown rapidly in recent years. High level evidence now exists for PRP in mild to moderate knee osteoarthritis and lateral epicondylitis. There is limited available literature for its use in hamstring injuries, despite being one of the most common muscle injuries across sports. This case addresses this gap by providing supporting evidence for PRP in hamstring injuries.

Conclusions: This case highlights the use of PRP as a minimally invasive and more cost-effective alternative to surgical management, which is crucial for patients considering nonoperative treatment options.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/yoga-induced-posterior-thigh-pain-a-case-report/