Korean J Radiol.  2006 Sep;7(3):193-198. 10.3348/kjr.2006.7.3.193.

Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius ("Tennis Leg")

• Kwak HS
• Han YM
• Lee SY
• Kim KN
• Chung GH

• KMID: 1114352
• DOI: http://doi.org/10.3348/kjr.2006.7.3.193

Abstract

OBJECTIVE
The purpose of this study was to demonstrate the ultrasonographic (US) findings of rupture and the healing process of the medial head of the gastrocnemius ("Tennis Leg"). MATERIALS AND METHODS: Twenty-two patients (age range: 30 to 45 years) with clinically suspected ruptures of the medial head of the gastrocnemius were referred to us for US examination. All the patients underwent US of the affected limb and the contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients were performed at two-week intervals during the month after injury and at one-month intervals during the following six months. RESULTS: Of the 22 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in seven patients (31.8%); the remaining 15 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 20 patients (90.9%). The thickness of the fluid collection, including the hematoma in the patients with complete rupture (mean: 9.7 mm), was significantly greater than that seen in the patients with partial tear (mean: 6.8 mm) (p < 0.01). The primary union of the medial head of the gastrocnemius with the soleus muscle in all the patients with muscle rupture and fluid collection was recognized via the hypoechoic tissue after four weeks. CONCLUSION: Ultrasonography is a useful imaging modality for the diagnosis and follow-up examination for the patients suffering with rupture of the medial head of the gastrocnemius.

Keyword

Muscles; Muscle, injuries; Muscle, gastrocnemius; Athletic injuries; Ultrasound (US)

MeSH Terms

Ultrasonography/*methods
Tendon Injuries/*ultrasonography
Rupture/ultrasonography
Prognosis
Muscle, Skeletal/*injuries/*ultrasonography
Middle Aged
Male
Leg Injuries/*ultrasonography
Humans
Follow-Up Studies
Female
Adult

Figure

• 

  Fig. 1 A 35-year-old male with a partial rupture of the medial head of the gastrocnemius at the musculotendinous junction. A. The longitudinal US image shows the medial head of the gastrocnemius muscle with partial discontinuity of the muscle fibers (double arrows). A small hypoechoic fluid collection (single arrow) is noted. G = gastrocnemius muscle, S = soleus muscle. B. The longitudinal US image one-week later shows a hyperechoic fluid collection (arrows). This fluid can be considered as most likely representing flesh blood. C. The longitudinal US image four weeks later shows the reparative process as a hypoechoic area (arrows) and a well-defined anechoic fluid collection.

• 

  Fig. 2 A 31-year-old male with complete rupture of the medial head of the gastrocnemius at the musculotendinous junction. A. The longitudinal US image obtained one day after the injury shows a poorly defined large fluid collection that separates the medial head of the gastrocnemius from the soleus muscle. G = gastrocnemius muscle, S = soleus muscle. B. The longitudinal US image obtained four weeks later shows union of the hypoechoic tissue between the distal ends of the medial head of the gastrocnemius with the soleus muscle (arrows). C. The longitudinal US image obtained three months following the injury shows the reparative process (arrows) as a hypoechoic area starting from the periphery of the fluid collection. D. The longitudinal US image obtained six months following injury shows the healing of the rupture as heterogeneous echogenicity (arrows) that corresponds to fibrous tissue interposed between the medial head of the gastrocnemius and the soleus muscle.

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