Medial Gastrocnemius Tear

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Medial Gastrocnemius Tear

Authors, Editors, Case Information Author: Michael Downing, DO Affiliation: Albany Medical Center PMR Co Author(s): Dr. Michael Bazzi, D.O., UC-Irvine PMR Dr. David Civitarese, D.O., Northwestern PMR Dr. Joshua Rothenberg - D.O., Board Certified PMR and Sports Medicine Senior Editor: Raul Rosario-Concepcion, MD Clinical Vignette: A 35-year-old male contractor presented to clinic with 5 of 10, non-radiating, right mid-calf pain after repeatedly kicking his work trailer. He has pain with weight-bearing, ankle plantar-flexion, and palpation of the medial head of the gastrocnemius and mid-belly of the soleus. Thompson test is negative. Type of Probe Used: Sonosite 15-4MHz probe #1 - Video View Video Short axis view demonstrating medial gastrocnemius tear while translating the ultrasound probe from distal to proximal. #2 - Video View Video Long axis view demonstrating medial gastrocnemius tear. Note the site of the tear with associated hypoechoic effusion while scanning. Long Axis View of Medial Gastrocnemius and Soleus, labeled Figure 2 – Long Axis – Free Gastrocnemius Aponeurosis tear (straight arrows). Note the thickening (star) and possible damage to the Soleus perimysium fibers (curved arrow). Long Axis View of Medial Gastrocnemius and Soleus - Unlabeled Long axis view of medial head of gastrocnemius and soleus muscle. Short Axis View of Medial Gastrocnemius and Soleus, labeled. Short Axis – Demonstrating Free Gastrocnemius Aponeurosis (FGA) disruption (arrow). Also note the mild hematic effusion (star). Short axis view of medial head of gastrocnemius and soleus muscle. Interpretation Image Interpretation: Grade III Medial Free Gastrocnemius Aponeurosis (FGA) tear. Teaching Pearl: A tear at the medial head of the gastrocnemius is also referred to as “Tennis Leg.” This injury results from sudden eccentric forces secondary to a rapid change in ankle position from plantarflexion to dorsiflexion. Dynamic testing with ankle plantarflexion and dorsiflexion should be performed to test the integrity of the Gastrocnemius muscles, Soleus muscle, and Achilles tendon. An ultrasound classification system grades the severity of medial gastrocnemius tears ranging from grade I to grade IV. This case presentation is most consistent with a grade III tear, defined by disruption of the free gastrocnemius aponeurosis (FGA). Grade I is a myoaponeurotic injury without muscle fiber retraction and is unlikely to have an associated hematoma. Grade II-a is defined by rupture affecting less than 50% of the total gastrocnemius aponeurosis (GA) width at the injury site. Grade II-B is similar to II-A but affects > 50% of the total GA width at the injury site. Grade II-A and II-B are commonly associated with hematoma formation. Grade IV is a mixed injury involving both the GA and FGA.
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

#1 - Video

#2 - Video

Long Axis View of Medial Gastrocnemius and Soleus, labeled

Long Axis View of Medial Gastrocnemius and Soleus - Unlabeled

Short Axis View of Medial Gastrocnemius and Soleus, labeled.

Short axis view of medial head of gastrocnemius and soleus muscle.

Interpretation

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