Medial Gastrocnemius Injury, Tennis Leg

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Medial Gastrocnemius Injury, Tennis Leg
Sandeep Johar
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
  • 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
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
  • 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


Ongoing Care
  • 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.
844.8 Sprain of other specified sites of knee and leg

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