Radiology Lectures | Radquarters

Ultrasound of Tennis Leg

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In this radiology lecture, we review the ultrasound appearance of tennis leg, including medial gastrocnemius and plantaris injury!

Key teaching points include:

  • Tennis leg = Injury to muscles of the calf. Tear of myotendinous junction of medial head of gastrocnemius, rupture of plantaris tendon (less common), in isolation or together
  • Classically described in tennis players, but can occur in various athletic activities (running, skiing) with extension of knee and forced dorsiflexion of ankle. Typically seen in middle-aged, active individuals
  • Clinical: Sudden sharp calf pain with associated popping/snapping sensation followed by tenderness and swelling
  • Gastrocnemius & soleus are pennate muscles. Fascicles attach obliquely to a tendon = Aponeuroses with long length of musculotendinous junction. Feathers converging on a single point
  • Triceps surae muscle = Two headed gastrocnemius, soleus and plantaris. Distal continuation of the gastrocnemius and soleus forms the Achilles tendon
  • Distal medial head of gastrocnemius where tapers over soleus = One of most commonly injured calf structures
  • Medial gastrocnemius tear appears as disrupted tendon fibers at aponeurosis with anechoic/hypoechoic fluid or hemorrhage +/- muscle retraction
  • May see retracted muscle fascicles. Hematoma can dissect between and extends into medial gastrocnemius and soleus muscles
  • Tx: Conservative (self-limiting). Surgical fasciotomy if compartment syndrome
  • Plantaris muscle arises from the posterosuperior aspect of lateral femoral condyle near lateral head origin of gastrocnemius muscle. Medially crosses posterior knee joint in oblique fashion
  • Plantaris continues into calf as a long, thin tendon traveling between medial head of gastrocnemius and soleus muscles. Courses distally at medial aspect of Achilles tendon, usually inserts onto calcaneus. Plantaris is absent in up to 20%
  • Plantaris injury/rupture less common than medial head gastrocnemius tear and typically more proximal in calf (at myotendinous junction)

    • To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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