A novel approach to sonographic examination in a patient with a calf muscle tear: a case report

Abstract

IntroductionRupture of the distal musculotendinous junction of the medial head of the gastrocnemius, also known as "tennis leg", can be readily examined using a soft tissue ultrasound. Loss of muscle fiber continuity and the occurrence of bloody fluid accumulation can be observed using ultrasound with the patient in the prone position; however, some cases may have normal ultrasound findings in this conventional position. We report a case of a middle-aged man with tennis leg. Ultrasound examination had normal findings during the first two attempts. During the third attempt, with the patient's calf muscles examined in an unconventional knee flexed position, sonographic findings resembling tennis leg were detected.Case presentationA 60-year-old man in good health visited our rehabilitation clinic complaining of left calf muscle pain. On suspicion of a ruptured left medial head gastrocnemius muscle, a soft tissue ultrasound examination was performed. An ultrasound examination revealed symmetrical findings of bilateral calf muscles without evidence of muscle rupture. A roentgenogram of the left lower limb did not reveal any bony lesions. An ultrasound examination one week later also revealed negative sonographic findings. However, he still complained of persistent pain in his left calf area. A different ultrasound examination approach was then performed with the patient lying in the supine position with his knee flexed at 90 degrees. The transducer was then placed pointing upwards to examine the muscles and well-defined anechoic fluid collections with areas of hypoechoic surroundings were observed.ConclusionFor patients suffering from calf muscle area pain and suspicion of tennis leg, a soft tissue ultrasound is a simple tool to confirm the diagnosis. However, in the case of negative sonographic findings, we recommend trying a different positional approach to examine the calf muscles by ultrasound before the diagnosis of tennis leg can be ruled out.

A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain

“…One might consider a diagnosis of a rupture of the distal musculotendinous junction of the medial head of the gastrocnemius muscle (tennis leg). This condition is often seen in athletes performing sudden acceleration and deceleration manoeuvres [ 10 ]. The patient denied any history of trauma, and the physical examination revealed localised pain at the medial aspect of the upper left leg.…”

Considerations in the Diagnosis and Accelerated Return to Sport of a Professional Basketball Player With a Triceps Surae Injury: A Case Report

“…Studies utilizing MRI, sonography, or surgical exploration show that plantaris injuries may occur in isolation or concomitantly with tears of the gastrocnemius, soleus, or popliteus, 4,7,15,22,27,37,63 but prolific edema can make the precise identification of the involved structures difficult. Magnetic resonance imaging studies suggest that the diagnosis of plantaris strain is appropriate when fluid is observed with a strong clinical suspicion, even when no tear is initially seen.…”

“…Nonsurgical treatment is typically administered for 3 to 16 weeks, particularly when there is involvement of the gastrocsoleus complex. 7,24,25 While immobilization is indicated during the acute phase of muscle healing due to histological factors such as capillary growth, granulation tissue formation, muscle fiber regeneration, and biomechanical tensile strength development, these factors have more precedence when healing, repair, and tissue regeneration are the goals. 30,38,39 In this case, immobilization, protected weight bearing, and edema-control strategies were implemented, with the aim to improve function by decreasing pain, inflammation, and muscle soreness; however, as the likelihood of an isolated plantaris rupture increased and the suspicion of a medial gastrocsoleus strain diminished, it was recognized that rehabilitation should focus on treating the objective clinical symptoms and on functional ability, because healing of the tendon was not the aim.…”

Pseudohypoparathyroidism: A Case Report of a Rare Disease with Uncommon Presentation Producing Diagnostic Dilemma

“…It virtually excluded epilepsy as there is no improvement of seizures even after combination anticonvulsant therapy. Recently it has been demonstrated that long-term anticonvulsant therapy, particularly when more than one drug is used, can precipitate hypocalcaemia 11 .…”