Age / Sex : 49 / M

Chief complaint : Sudden calf pain during strenuous sports activity

What is your diagnosis?


Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 김성준(Sungjun Kim), 강남세브란스병원(Gangnam Severance Hospital)

Gastrocnemius medial head rupture (tennis leg)

Discussion

Findings:

On panoramic acquisition of ultrasonography at the medial calf, discontinuity of muscle belly and fluid collection between soleus aponeurosis and gastrocnemius medial head is seen.

Differential Diagnosis:

none

Discussion:

Tennis leg is induced not only by tennis but also by the other strenuous sports activities or abrupt running/jumping initiation. It typically occurs in active and/or middle-aged individuals. Common clinical presentation is sharp pain and “popping sound” within the calf, and is associated with focal tenderness and swelling.

It is more commonly due to tear of the myotendinous junction of the gastrocnemius medial head, but can be accompanies with plantaris tendon rupture. Isolate plantaris tendon rupture can occur, but appear to be less common.

MRI can also be used for the diagnosis, but ultrasound is enough for the detection and extent assessment. Ultrasound demonstrates fluid between gastrocnemius medial head and soleus muscle, which is the layer of their myotendinous junction. A tear in the deep surface of gastrocnemius may be seen as a disruption in contour and echogenicity of muscle fibers. A torn plantaris tendon may also be identified.

Treatment is usually conservative except for the case of combined compartment syndrome.

References:

1. Delgado GJ, Chung CB, Lektrakul N et-al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology. 2002;224 (1): 112-9. 


2. Jamadar DA, Jacobson JA, Theisen SE et-al. Sonography of the painful calf: differential considerations. AJR Am J Roentgenol. 2002;179 (3): 709-16.


3. Bianchi S, Martinoli C, Abdelwahab IF et-al. Sonographic evaluation of tears of the gastrocnemius medial head ("tennis leg") J Ultrasound Med. 1998;17 (3): 157-62.