Medial Gastrocnemius Injury, Tennis Leg

By admin Last updated Oct 14, 2023

Ovid: 5-Minute Sports Medicine Consult, The

Sandeep Johar

Basics

Description

Musculotendinous disruption of varying degrees in the medial head of the gastrocnemius muscle that results from an acute, forceful push-off with the foot

Risk Factors

Male
4th to 6th decades of life
High-risk sports, including hill running, jumping, and tennis
Muscles that have not been properly warmed up may be greater at risk.
Recurrent calf strains

Diagnosis

Audible pop when the injury to the medial calf occurs
Pain in the area of the calf with radiation to the knee or the ankle
Pain with range of motion (ROM) of the ankle
Swollen leg that extends down to the foot or ankle
Bruising of the calf

History

Athlete reports audible pop when the injury to the medial calf occurred, and the patient complains of feeling like a stick struck his or her calf.

Physical Exam

Asymmetric calf swelling and discoloration
Visible defect may be present in the medial gastrocnemius muscle.
Tenderness on palpation of the medial gastrocnemius muscle (more painful at the medial musculotendinous junction)
A palpable defect may be evident at the medial musculotendinous junction.
Palpation of the Achilles tendon demonstrates an intact tendon.
Peripheral pulses should be normal.
Pain with passive ankle dorsiflexion
Pain with active resistance to ankle plantarflexion
Thompson test is negative: Thompson test should always be performed in the clinical setting of atraumatic, acute-onset pain in the posterior lower leg associated with an audible “pop.”

Diagnostic Tests & Interpretation

Imaging

X-ray films of the tibia/fibula may be ordered to rule out an avulsion fracture.
MRI: The most sensitive and specific imaging method to show the area of disrupted soft tissue
US: Will aid in ruling out a deep vein thrombosis (DVT)

Differential Diagnosis

Baker cyst rupture
DVT
Plantaris tendon rupture
Achilles tendon rupture
Acute compartment syndrome after rupture of the medial head of the gastrocnemius
Chronic exertional compartment syndrome (posterior)
Posterior tibial tendon rupture or tendonitis
Popliteal artery entrapment syndrome
Anomalous gastrocnemius muscle rupture

P.381

Treatment

Prevention/reduction of swelling: Elevation, compression, and ice for 20 min 3–4 × a day
Early weight bearing (may need crutches and/or bilateral heel lifts for normal gait)
Ankle/foot bracing to keep the ankle in maximal tolerable dorsiflexion: In the early stages of treatment, using the splint at night may be helpful.

Medication

NSAIDs: Clinicians must carefully consider pain therapy in the 1st 48 hr, as decreased platelet activity may result in increased bleeding and larger hematoma formation with resultant effects on healing.

Ibuprofen: Adult: 600 mg PO q8h; children: 10 mg/kg PO q8h
Naproxen: Adult: 250–500 mg PO b.i.d.
Ketorolac: Adult: 30 mg IV/IM q6h or 10 mg PO q4–6h

Additional Treatment

Ice therapy for control of pain and swelling
Active resistance dorsiflexion exercises until the athlete is pain-free
Apply compression dressing from the metatarsal heads to the gastrocnemius for the 1st 2 wks.
Partial weight-bearing ambulation as soon as tolerable to maximize the contact of the sole of the foot to the ground
Stationary cycling, leg presses, and heel raises
Proprioception and balance training

Ongoing Care

Prognosis

Prognosis is excellent for the tennis leg sufferer to return to sports endeavors.
Noncompliance can prevent players from returning to sports for 3–4 mos.
Early and aggressive rehabilitation allows most patients to recover within a few weeks.

Additional Reading

Best TM, McCabe RP, Corr D, et al. Evaluation of a new method to create a standardized muscle stretch injury. Med Sci Sports Exerc. 1998;30:200–205.

Bianchi S, Martinoli C, Abdelwahab IF, et al. Sonographic evaluation of tears of the gastrocnemius medial head (“tennis leg”). J Ultrasound Med. 1998;17:157–162.

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;224:112–119.

Millar AP. Strains of the posterior calf musculature (“tennis leg”). Am J Sports Med. 1979; 7:172–174.

Zarins B, Ciullo JV. Acute muscle and tendon injuries in athletes. Clin Sports Med. 1983;2:167–182.

Codes

ICD9

844.8 Sprain of other specified sites of knee and leg