Medial Gastrocnemius Aponeurosis Tear And Hematoma

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Medial Gastrocnemius Aponeurosis Tear And Hematoma

Authors, Editors, Case Information Author: Alexandre Mazar, MD Affiliation: Bassett Healthcare Network Co Author(s): Robert Gapinski, MD, CAQSM, RMSK Senior Editor: Adam Lewno, DO Clinical Vignette: A 37-year-old male presents with a 6-month history of left calf pain that developed while running. He reported a popping sensation in his left lower leg at the start of his pain without any bruising observed. Exam was only notable for focal tenderness over the distal medial gastrocnemius muscle with intact range of motion and strength of the left ankle. Thompson test was negative Type of Probe Used: 4-18 MHz linear array transducer Labeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis Short Axis view of Left Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma (Star) Unlabeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis Short Axis View of Left Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma Labeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis Long Axis view of Left Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma (Star) Unlabeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis Long axis view of Left Medial Gastrocnemius and Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma Interpretation Image Interpretation: The medial gastrocnemius muscle fibers appear intact at the gastrocnemius-soleus junction/aponeurosis. There is an anechoic defect, elliptical in shape at the free gastrocnemius aponeurosis with mixed echogenicity in appearance, likely representing a chronic hematoma (star). Teaching Pearl: Medial gastrocnemius tears can occur from sudden plantar flexion of the ankle or from sudden knee extension with the ankle in dorsiflexion. Tears between the medial gastrocnemius and soleus occur more commonly than the lateral gastrocnemius and soleus. In this particular case, the medial gastrocnemius muscle perimysium was intact (type I injury) as well as the gastrocnemius aponeurosis (Type II injury). The hematoma was located at the free gastrocnemius aponeurosis which is consistent with a type III medial gastrocnemius tear and was considered chronic in appearance due to its mixed echogenicity. Evaluation of the medial gastrocnemius and the soleus dynamically with passive plantar and dorsiflexion is important to evaluate under ultrasound as asynchronous movements of these two structures has been associated with prolonged return-to-activity.
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Authors, Editors, Case Information

Labeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Unlabeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Labeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Unlabeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Interpretation

UPCOMING EVENTS

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