Abstract
Objective
The objective was to describe the imaging findings following acute injury to the calf musculature.
Design and patients
We retrospectively reviewed 59 MR examinations in patients who sustained injuries to the calf muscle from April 2001 to September 2004 (48 men, 11 women), with an average age of 31 and 47 years respectively (range in men 20–53; range in women 33–63). Attention was directed to the frequency of muscle involvement, the location of the injury within the musculotendinous unit and the extent of the injury.
Results and conclusions
A total of 79 separate sites of strain injury were identified (39 solitary, 20 dual). Of the 39 isolated strains, injury to the gastrocnemius was most common (19 out of 39; 48.7%), preferentially involving the medial head in 18 cases and the lateral head in 1 case. The soleus was also commonly involved (18 out of 39; 46.2%), with 2 cases (5.1%) of distal avulsions of the plantaris. Of the 20 dual injuries, a combination of gastrocnemius injury with soleus injury was the most frequent finding (12 out of 20; 60%). Dual injuries of both heads of the gastrocnemius muscles were demonstrated in 4 cases (20%), with the soleus and tibialis posterior injured in 3 cases (15%). A combination of soleus and flexor hallucis longus injury was seen in 1 case (5%).
Conclusion
This retrospective study utilizing MRI demonstrates that the medial head of the gastrocnemius is the most commonly injured muscle of the calf, closely followed by the soleus, the latter finding rarely reported in the sonographic literature. Dual injuries of the calf muscle complex occur much more commonly than previously reported and may be of prognostic significance.
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References
Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med 2002; 36(1): 39–44.
Powell RW. Lawn tennis leg. Lancet 1883; 2: 44.
Jackson DW, Feagin JA. Quadriceps contusion in young athletes. Relation of severity of injury to treatment and prognosis. J Bone Joint Surg Am 1973; 55: 95–105.
Garrett WE Jr. Muscle strain injuries. Am J Sports Med 1996; 24(6 Suppl): S2–S8.
Elias JJ, Faust AF, Chu YH, Chao EY, Cosgarea AJ. The soleus muscle acts as an agonist for the anterior cruciate ligament. An in vitro experimental study. Am J Sports Med 2003; 31(2): 241–246.
Bermudez K, Knudson MM, Morabito D, Kessel O. Fasciotomy, chronic venous insufficiency, and the calf muscle pump. Arch Surg 1988; 133(12): 1356–1361.
Mohanna PN, Haddad FS. Acute compartment syndrome following non-contact football injury. Br J Sports Med 1997; 31(3): 254–255.
Jarolem KL, Wolinsky PR, Savenor A, Ben-Yishay A. Tennis leg leading to acute compartment syndrome. Orthopedics 1994; 17(8): 721–723.
Anouchi YS, Parker RD, Seitz WH Jr. Posterior compartment syndrome of the calf resulting from misdiagnosis of a rupture of the medial head of the gastrocnemius. J Trauma 1987; 27(6): 678–680.
Russell GV Jr, Pearsall AW 4th, Caylor MT, Nimityongskul P. Acute compartment syndrome after rupture of the medial head of the gastrocnemius muscle. South Med J 2000; 93(2): 247–249.
Touliopolous S, Hershman EB. Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med 1999; 27(3): 193–204.
Kane D, Balint PV, Gibney R, Bresnihan B, Sturrock RD. Differential diagnosis of calf pain with musculoskeletal ultrasound imaging. Ann Rheum Dis 2004; 63(1): 11–14.
Gaulrapp H. “Tennis leg”: ultrasound differential diagnosis and follow-up. Sportverletz Sportschaden 1999; 13(2): 53–58.
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.
Dessl A, Bodner G, Springer P et al. Ruptures of the medial gastrocnemius muscle: diagnosis with high resolution ultrasound. Ultraschall Med 1998; 19(5): 230–233.
Menz MJ, Lucas GL. Magnetic resonance imaging of a rupture of the medial head of the gastrocnemius muscle. A case report. J Bone Joint Surg Am 1991; 730(8): 1260–1262.
Millar AP. Strains of the posterior calf musculature (“tennis leg”). Am J Sports Med 1979; 7(3): 172–174.
Gilbert TJ Jr, Bullis BR, Griffiths HJ. Tennis calf or tennis leg. Orthopedics 1996; 19(2): 179–184.
Arner O, Lindholm A. What is tennis leg? Acta Chir Scand 1958; 116: 73–75.
Bianchi S, Martinoli C, Abdelwahab IF, Derchi LE, Damiani S. Sonographic evaluation of tears of the gastrocnemius medial head (“tennis leg”). J Ultrasound Med 1998; 17: 157–162.
Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. Radiographics 2000; 20: 103–120.
Helms CA, Fritz RC, Garviun GJ. Plantaris muscle injury: evaluation with MR imaging. Radiology 1995; 195: 201–203.
Leekam RN, Agur AM, McKee NH. Using sonography to diagnose injury of the plantaris muscle and tendons. AJR Am J Roentgenol 1999; 172: 185–189.
Hamilton W, Klostermeier T, Lim E, Moulton JS. Surgically documented rupture of the plantaris muscle: a case report and literature review. Foot Ankle Int 1977; 18: 522–523.
Cavalier R, Gabos PG, Bowen JR. Isolated rupture of the soleus muscle: a case report. Am J Orthop 1998; 27(11): 755–757.
Howard PD. Differential diagnosis of calf pain and weakness: flexor hallucis longus strain. J Orthop Sports Phys Ther 2000; 30(2): 78–84.
Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury. Skeletal Radiol 2003; 32(10): 582–589.
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Koulouris, G., Ting, A.Y.I., Jhamb, A. et al. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol 36, 921–927 (2007). https://doi.org/10.1007/s00256-007-0306-6
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DOI: https://doi.org/10.1007/s00256-007-0306-6