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 non-radiating right mid-calf pain rated as a 5 out of 10 severity. The pain started after repeatedly kicking his work trailer. He had pain with weight-bearing, ankle plantar-flexion, and palpation of the medial head of the gastrocnemius and mid-belly of the soleus. Thompson test was negative. Type of Probe Used: Sonosite Linear 15-4MHz Unlabeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Unlabeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Labeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Labeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle, demonstrating Free Gastrocnemius Aponeurosis (FGA) disruption (arrow). Also note the mild hematic effusion (star). Unlabeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Unlabeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Labeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle Labeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle with evidence of Free Gastrocnemius Aponeurosis tear (straight arrows). Note the thickening (star) and possible damage to the Soleus perimysium fibers (curved arrow). #5 - Video View Video Short axis cine of the medial head of gastrocnemius aponeurosis from distal to proximal with a hypoechoic area consistent with medial gastrocnemius tear. #6 - Video View Video Long axis cine of the medial head of gastrocnemius aponeurosis from distal to proximal with a hypoechoic area consistent with medial gastrocnemius tear. Interpretation Image Interpretation: Grade III Medial Free Gastrocnemius Aponeurosis (FGA) tear. Teaching Pearl: A medial gastrocnemius tear, also known as "tennis leg," results from sudden eccentric force, often due to rapid ankle dorsiflexion with the knee extended. Ultrasound should evaluate the medial gastrocnemius myotendinous junction, gastrocnemius-soleus interface, and free gastrocnemius aponeurosis for fiber disruption and hematoma. Perform dynamic testing with ankle plantarflexion and dorsiflexion to visualize tissue motion and tear behavior. You may also consider Baker's cyst rupture and deep venous thrombosis in the differential for calf pain and swelling. 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, et al. 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
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle

Labeled Short Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle

Unlabeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle

Labeled Long Axis View of the Medial Head of Gastrocnemius Aponeurosis and Soleus Muscle

#5 - Video

#6 - Video

Interpretation

UPCOMING EVENTS

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