Novel treatment of Refractory Proximal Hamstring Tendinopathy with Radiofrequency Ablation of the Posterior Femoral Cutaneous Nerve

 

Proximal hamstring tendinopathy (PHT) is a common condition in the athletic population. Conventional treatment options for PHT includes non-surgical interventions such as physical therapy, oral analgesics, and topical glyceryl trinitrate (GTN). Interventional treatments encompass corticosteroid injections, platelet-rich plasma injections (PRP), extracorporeal shockwave therapy (ESWT), low-level laser therapy (LLLT), and surgical repair of the tendon (Challoumas, 2020). However, the results of these interventions are sometimes inadequate for relieving pain. The perineal branch of the posterior femoral cutaneous nerve (PFCN) is known to course near the proximal tendon of the long head of the biceps femoris (Stępień, 2019). We hypothesize that this branch innervates the proximal hamstring and that ablating this branch could help improve refractory pain in PHT. We present a case of chronic pain in a patient with PHT who experienced significant pain relief from a prognostic block of the PFCN and was effectively treated using radiofrequency ablation (RFA) of the nerve. This is a novel treatment for refractory pain in patients with PHT.