Rute Santos 1,2,3*
1 Polytechnic University of Coimbra, Coimbra Health School, Rua da Misericórdia, lagar dos Cortiços, S.
Martinho do Bispo, 3045-093 Coimbra, Portugal
2 H&TRC—Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra,
Rua 5 de Outubro, 3045-043 Coimbra, Portugal
3 CIPER-UC – Interdisciplinary Center for the Study of Human Performance, University of Coimbra, 3004-531
Coimbra, Portugal
* Correspondence: rutemartinssantos@gmail.com; rutesantos@estesc.ipc.pt
A middle aged man presented with a painful left leg after a short run with his little son. The patient reported a sudden pain in the posterior region of the calf, with a sensation of something “snapping”.
Examination revealed local tenderness and swelling and some restriction of ankle movement due to pain. After ultrasound (US) confirmation of the diagnosis, the patient started physiotherapy treatment.
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CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q1 is: Large fluid collection between the gastrocnemius and soleus muscles |
CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q1 is: Large fluid collection between the gastrocnemius and soleus muscles |
Image 3: B-mode image of the distal portion of the myotendinous junction of the left medial gastrocnemius muscle, longitudinal view. The white arrows show the distance between the muscle and the tendon.
CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q2 is: Tear of the myotendinous junction of the left gastrocnemius muscleDiscussionUS demonstrated fluid deep to the medial gastrocnemius and superficial to the soleus muscle, most prominent at the level of the myotendinous junction and distal region of the medial gastrocnemius muscle. Calf muscle tear injury, also known as “tennis leg”, is a relatively common clinical condition involving damage to the medial head of the gastrocnemius muscle. A tear in the distal gastrocnemius and myotendinous junction may be seen as a disruption in contour and echogenicity of muscle fibers, often seen along a nearby fluid collection representing hematoma (the echogenicity of this fluid may vary depending the time from the trauma). Muscle tears located in the calf region are often associated with other pathologies such as Achilles tendinosis making the correct diagnosis difficult. The physical exam and diagnostic US add up to the final diagnosis and provide useful information for treatment [1]. Conclusion“Tennis leg”, a lesion in the myotendinous region of the medial gastrocnemius muscle, should be considered in patients complaining of a an acute and sharp pain in the region of the triceps surae often involving a sudden, subjective “snapping” sensation. Ultrasound examination provides information of lesion location and the presence of hematoma. Conflicts of Interest:“The authors declare no conflict of interest.” References
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CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q2 is: Tear of the myotendinous junction of the left gastrocnemius muscleDiscussionUS demonstrated fluid deep to the medial gastrocnemius and superficial to the soleus muscle, most prominent at the level of the myotendinous junction and distal region of the medial gastrocnemius muscle. Calf muscle tear injury, also known as “tennis leg”, is a relatively common clinical condition involving damage to the medial head of the gastrocnemius muscle. A tear in the distal gastrocnemius and myotendinous junction may be seen as a disruption in contour and echogenicity of muscle fibers, often seen along a nearby fluid collection representing hematoma (the echogenicity of this fluid may vary depending the time from the trauma). Muscle tears located in the calf region are often associated with other pathologies such as Achilles tendinosis making the correct diagnosis difficult. The physical exam and diagnostic US add up to the final diagnosis and provide useful information for treatment [1]. Conclusion“Tennis leg”, a lesion in the myotendinous region of the medial gastrocnemius muscle, should be considered in patients complaining of a an acute and sharp pain in the region of the triceps surae often involving a sudden, subjective “snapping” sensation. Ultrasound examination provides information of lesion location and the presence of hematoma. Conflicts of Interest:“The authors declare no conflict of interest.” References
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