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 presented 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 Unlabeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis Unlabeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma Labeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis Labeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma (Star) Unlabeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis Unlabeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma Labeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis Labeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis with Free Gastrocnemius Aponeurosis Hematoma (Star) 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 commonly occur with sudden plantarflexion or sudden knee extension with the ankle dorsiflexed. Tears at the medial gastrocnemius-soleus interface or free gastrocnemius aponeurosis are more common than lateral-sided injuries and may show a hypoechoic defect with hematoma on ultrasound. It's important to identify the tear plane and characterize the hematoma, especially when symptoms persist or the fluid collection becomes complex. Dynamic ankle motion can help confirm disrupted aponeurotic mechanics. Differential for pain and swelling in this area may include Baker cyst rupture and deep venous thrombosis when clinically indicated. 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):112-119. doi:10.1148/radiol.2241011067 2. Pedret C, Balius R, Blasi M, Dávila F, Aramendi JF, Masci L, de la Fuente J. Ultrasound classification of medial gastrocnemious injuries. Scand J Med Sci Sports. 2020;30(12):2456-2465. doi:10.1111/sms.13812 3. Bright JM, Fields KB, Draper R. Ultrasound diagnosis of calf injuries. Sports Health. 2017;9(4):352-355. doi:10.1177/1941738117696019
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Unlabeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Labeled Long Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Unlabeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Labeled Short Axis View of the Medial Gastrocnemius Soleus Aponeurosis

Interpretation

UPCOMING EVENTS

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