Gastroc Tear in a Collegiate Basketball Player

Abstract

HISTORY: A 21-year-old male basketball player presented with calf pain at the end of the basketball season. He had a history of a “torn gastroc” in high school and had a deformity since that time. He complained of a gradual onset of deep achy pain over the left gastrocnemius muscle. The pain was associated with swelling and tightness in his lower leg and general fatigue after long periods of activity. The symptoms were improved with compression and stretching and resolved with rest. Past medical history is significant for left hip chondroblastoma, resected 6 years previously. Review of systems is significant for general malaise without fever or chills; decreased appetite and 12 pound weight loss during training over the previous 3 months. He complained of occasional migraine headaches. He denied chest pain, dyspnea on exertion, but complained of mild intermittent diarrhea. PHYSICAL EXAMINATION: Afebrile, appears gaunt, weight 185. No scleral icterus. Heart rate and rhythm regular. Lungs clear bilaterally. Abdomen: muscular. No organomegaly or masses. Left lower extremity evaluation revealed a normal hip and knee exam. The ankle examination was normal except for slightly decreased dorsiflexion. The left calf appeared mildly deformed and swollen just proximal to the musculotendinous junction. On palpation, there was an approximately 10 cm compressible spongy mass over the distal gastrocnemius in the area of his “gastroc tear”. There was no point tenderness. The gastrocnemius and soleus muscles had slight decreased flexibility. Strength was 4+/5 compared to the right calf. Sensation and reflexes were normal in bilateral knees and ankles. There were 2+ pulses in the bilateral lower extremities. DIFFERENTIAL DIAGNOSIS: Chronic Gastrocnemius/Soleus Tear Recurrence of Chondroblastoma - Mass Popliteal entrapment due to mass Exertional Compartment Syndrome Stress fracture versus pathologic fracture Hemangioma TEST AND RESULTS: X-ray: Bilateral tibia and fibula: No fracture or mass noted. MRI: Large hypervascular enhancing soft tissue mass in the left soleus muscle consistent with hemangioma Biopsy: Sarcoma FINAL WORKING DIAGNOSIS: Alveolar soft-part sarcoma TREATMENT AND OUTCOMES: Oncology consult; non-surgical management with sub-cutaneous interferon. At present the athlete continues to train.