LEG INJURY - TENNIS

Abstract

HISTORY: A 53-year old male recreational tennis player was reaching for a ball when he felt excruciating pain in his right heel and calf. He noted a mass in his calf. He subsequently fell to the ground, unable to bear weight on his right side. Upon presentation to the emergency department, the patient's entire lower limb was extremely swollen such that a venous ultrasound was obtained to rule out deep venous thrombosis (DVT). No evidence of DVT was noted, and the patient was scheduled for an orthopaedic follow-up the following week. Of note was the fact that several months prior to injury, the patient had been diagnosed with bilateral Achilles peritendinitis which had responded well to physical therapy. PHYSICAL EXAMINATION Upon examination, the patient demonstrated significant swelling of the right calf and ankle. A defect was palpable in the Achilles tendon, and point tenderness was observed in the medial calf. Upon testing, the patient was noted to have weakness of plantarflexion and a positive Thompson's test. He was neurovascularly intact with no motor or sensory deficits in the affected lower extremity. DIFFERENTIAL DIAGNOSIS: Deep venous thrombosis Achilles tendon rupture Gastrocnemius musculotendinous tear TESTS AND RESULTS: OFFICE RADIOGRAPHS: Lower leg antero-posterior / lateral tibia/fibula and ankle radiographs: AP and lateral radiographs of the leg and ankle were unremarkable. No fractures or soft tissue abnormalities were visualized. Due to the tremendous calf and lower leg swelling, a lower extremity MRI study was obtained. MAGNETIC RESONANCE IMAGING STUDY: T1, T2, and proton density images were obtained. A partial tear of the distal Achilles tendon was visualized. A partial rupture of the medial head of the gastrocnemius muscle was demonstrated. FINAL/WORKING DIAGNOSIS: Ipsilateral Achilles tendon and medial head gastrocnemius musculotendinous rupture. TREATMENT: Surgical repair of the Achilles tendon rupture with FHL/plantaris tendon augmentation. A plantarflexed walking boot, full weight bearing and physical therapy for range of motion and progressive strengthening beginning at seven days after surgery. Return to sports at approximately 4–5 months after surgery.