Tennis Leg Research Articles

Acute injuries in Badminton from 10 to 66years of age: an epidemiological study of 140 cases among all types of practice.

The main objective of this retrospective study was to establish an epidemiological overview of patients admitted to an Emergency department specialized in musculo-skeletal trauma for acute lesions related to Badminton practice in the period from January 1st 2010 to January 1st 2015. There were 135 patients with 140 admissions and 146 total number of injuries. There were 67 females (48%) and 73 males (52%). The mean age was 28 ± 13.8years, ranging 10-66years. 91 patients (65%) could be contacted by telephone to fill a questionnaire aimed at completing the information provided by the medical records. 129 lesions (88.3%) were located to the lower limbs, 16 (11%) to the upper limbs, and one (0.7%) at the head. For the whole series, there were 89 sprains (60.9%), 32 tendino-muscular lesions (21.9%), 13 fractures (8.9%), 5 dislocations (3.4%), 3 painful contusions (2.1%), 3 meniscal injuries (2.1%) and one wound (0.7%). In the lower limbs, lateral ankle sprain was the most frequent diagnosis (43.4%), followed successively by rupture of the Achilles tendon (13.9%), tennis leg (8.5%), and mid-foot sprain (6.9%). Of the 146 lesions, 117 (80.1%) received non-operative treatment, 28 (19.1%) received surgical treatment in the operation room, and one simple wound (0.7%) was sutured in the emergency room. Lateral ankle sprains followed by tendino-muscular lesions of the calf are by far the most frequent lesions of badminton. Modification of the shoes of badminton players should be considered to decrease the high incidence of ankle injuries.

Evaluation of the plantaris tendon: cadaver anatomy study with ultrasonographic and clinical correlation with tennis leg injury in 759 calves.

The role of the plantaris muscle (PM) in the literature is not clear. The objectives of this study were as follows: (1) to study PM at the interface between the medial gastrocnemius and soleus muscle in a cadaveric series, (2) to compare anatomic results with ultrasound (US) in the general population, and (3) to identify the potential role of the PM in the genesis of tennis leg (TL) injury. First, a cadaveric study was undertaken on six cadavers for descriptive and functional PM anatomy. Second, US evaluation was carried out for 670 calves in 335 subjects with no suspicion of a clinical tear in the thigh or calf muscle (group 1) and for 89 calves in 89 patients with tear symptoms (group 2). Study criteria were the presence or absence of PM tendon and the width measurement if present. The PM was present in all cadavers. Traction on the tendon showed its "limited" mobility due to the connective tissue adherence mentioned with no apparent gliding of PM, promoting TL injury. In US, 37 PM were absent (4.35%) in 23 subjects. PM tendon width measurement of group 1 and group 2 was, respectively, 3.93 + / - 1.10mm and 3.96 + / - 1.10mm. No statistically significant differences between width measurements were found according to side (P = 0.74) or group (P = 0.69). Significant differences in width were only found between genders in group 1 (P = 0.014). PM were absent in 4.35% population. The contraction of PM can promote tennis leg injury by increasing the shear forces at the level of the distal inter-aponeurotic region.

Application of localized cryotherapy (-160 °C) on tennis leg injury: tissue remodeling and recovery in an elite Italian soccer player

article: Application of localized cryotherapy (-160 °C) on tennis leg injury: tissue remodeling and recovery in an elite Italian soccer player - Medicina dello Sport 2021 September;74(3):537-46 - Minerva Medica - Journals

Diagnosis and follow-up MRI evaluation of tennis leg:New understanding of the pathogenesis and imaging

ObjectivesTo evaluate the Magnetic resonance imaging (MRI) findings of patients with a clinical diagnosis of tennis leg and to explore the pathogenesis of tennis leg. MethodsA retrospective review of 58 (45 men, 13 women; age range, 7–81 years; mean age, 46.7 years) patients with a clinical diagnosis of tennis leg at our hospital during a 64-month period (May 2014 through Sep 2019) was conducted. All patients underwent MRI scan. Follow-up MRI was performed on 4 patients. Images findings, including integrity of the myotendinous junction and tendon of the gastrocnemius and soleus, and presence of fluid collection were analyzed. ResultsMRI revealed fluid collection between the medial head of the gastrocnemius and soleus in 44 cases (72.1%). In 25 cases (41.0%), the collected fluid spread to around the medial border of fascia cruris. Fifty-five cases (90.2%) had edema or disruption of the gastrocnemius, with most cases (n = 55) showing edema or disruption of the medial head of the gastrocnemius at the myotendinous junction. Twenty-two (36.1%) cases had edema or disruption of the soleus, with most cases (n = 17) showing edema or disruption of the soleus at the myotendinous junction. Plantaris tendon disruption was observed in 7 cases (11.5%). A thick area of reparative tissue at the distal myotendinous junction of the medial head of the gastrocnemius was observed in all 4 MRI patients followed up. ConclusionAbnormalities of the medial head of the gastrocnemius at the myotendinous junction and tendon appear to be more common than those of the plantaris tendon. Reparative tissue at the distal myotendinous junction of the medial head of the gastrocnemius may be an important specific indication of chronic tennis leg injury.

"Tennis Leg": A State-of-the-Science Review.

Tennis leg (TL), a musculotendon injury to the gastrocnemius, has been associated with the eponymous sport since 1883. This article examines the historical context of TL as a sports compared with an occupational injury. This was juxtaposed with the history of tennis elbow, a tendon injury to the upper extremity also associated with sport. Bibliometric databases (PubMed, Web of Science [WOS], Hathi Trust) were keyword-searched; relevant citations were investigated in depth. The search yielded 71 citations for TL (PubMed). The majority (n = 43) were key word linked to sport terms; only one was linked to work-related search terms. Furthermore, none of the top four cited publications (Web of Science) alluded to work-related risk factors in TL in full textual analysis. Hathi Trust yielded the earliest work-related case, reported in a non-biomedical source. Tennis elbow was more frequently reported (n = 189 citations in PubMed) and more frequently linked (n = 193; 9.7%) to occupational search terms. The history of TL, juxtaposed with tennis elbow, demonstrates how nosology can influence but does not wholly explain disease attribution, potentially to the detriment of taking into account occupational causality. The lack of recognition of occupational factors revealed in this literature search was notable because TL occurred most commonly in males of working age. By providing perspective on how historical context and nosology can affect the conceptualization of disease, this review may help inform prevention, treatment, and regulatory policy.

Morphological study of plantaris muscle in cadavers and its clinical significance

Plantaris muscle though a vestigial muscle and absent in 10% of cases still has a diagnostic and clinical importance e.g., of its being an isolated cause of tennis leg. This study was done on 50 lower limbs of 25 adult cadavers for morphology and prevalence of plantaris muscle in our region. We have observed absence of plantaris muscle in about 26% of limbs and both belly and tendon of the plantaris muscle had a wide variation in its length and width. In two of the limbs double head of origin of muscle was seen. Keywords: Double Head, Plantaris, Vestigial.

Ultrasound classification of medial gastrocnemious injuries.

High-resolution ultrasound (US) has helped to characterize the "tennis leg injury" (TL). However, no specific classifications with prognostic value exist. This study proposes a medial head of the gastrocnemius injury classification based on sonographic findings and relates this to the time to return to work (RTW) and return to sports (RTS) to evaluate the prognostic value of the classification. 115 subjects (64 athletes and 51 workers) were retrospectively reviewed to asses specific injury location according to medial head of the gastrocnemius anatomy (myoaponeurotic junction; gastrocnemius aponeurosis (GA), free gastrocnemius aponeurosis (FGA)), presence of intermuscular hematoma, and presence of gastrocnemius-soleus asynchronous movement. Return to play (RTP; athletes) and return to work (RTW; occupational) days were recorded by the treating physician. This study proposes 5 injury types with a significant relation to RTP and RTW (P<.001): Type 1 (myoaponeurotic injury), type 2A (gastrocnemius aponeurosis injury with a <50% affected GA width), type 2B (gastrocnemius aponeurosis with >50% affected GA width), type 3 (free gastrocnemius aponeurosis (FGA) tendinous injury), and type 4 (mixed GA and FGA injury). The longest RTP/RTW periods were associated with injuries with FGA involvement. Intermuscular hematoma and Gastrocnemius-soleus asynchronous motion during dorsiflexion and plantarflexion were observed when the injury affected >50% of the GA width, with or without associated FGA involvement, and this correlated with a worse prognosis. The proposed classification can be readily applied in the clinical setting although further studies on treatment options are required.

Deep vein thrombosis after “Tennis Leg” injury: A clinical case

Abstract Background “Tennis leg” is a common lesion in sports with quick accelerations and stops, consisting of an injury to the fascia joining the soleus muscle with the medial gastrocnemius. In these cases, a differential diagnosis must be performed, considering possible complications such as a deep vein thrombosis (DVT) of the veins of the deep musculature of the lower leg. The aim of this clinical case is to alert professionals regarding possible complications of these injuries and to train professionals to detect a possible vascular problem. Case Description A 42 year old male who attends a physical therapy consultation 24 hours after suffering a “muscle pull” in the gastrocnemius. After a medical diagnosis of tennis leg he received appropriate standard regulated physical therapy treatment procedures. A follow-up ultrasound exam was performed eight days after the injury and at 14 days after a worsening of symptoms, at which point a vascular alteration was detected which was diagnosed and treated as DVT. Results The patient came for consultation and we observed a vascular alteration and therefore we referred the person to the emergency room, where he was diagnosed with DVT. Discussion DVT is a possible complication of gastrocnemius injuries. The present case describes a clinical presentation of DVT after 14 days evolution. It is essential to evaluate and reevaluate the clinical condition of the patient with all the diagnostic tools possible to detect possible red flags. Conclusion Ultrasound is an essential tool for the detection of possible complications after a musculoskeletal injury.

MRI presentation and pathogenesis of tennis legs

Objective To evaluate the imaging features of MRI of tennis legs and to explore the pathogenesis of tennis legs. Methods A retrospective analysis was made on the MRI images of 38 patients with tennis legs which met the criteria and were clinically diagnosed in our hospital from May 2014 to June 2018. All patients underwent non-enhanced MRI. Coronal T1WI、T2WI fast spin echo (TSE) and transverse proton density weighted imaging (PDWI) were performed. The signs of fluid collection between gastrocnemius muscle (GM) and soleus muscle (SM),muscle and tendon injuries, superficial vein dilatation of calf were observed and recorded. Results Coronal T1WI, T2WI TSE and transverse PDWI sequences showed 30 (75.0%) places fluid collection (hematoma or effusion) between medial head of the gastrocnemius muscle (MCM) and SM,11 (27.5%) places fluid collection (hematoma or effusion) between lateral head of gastrocnemius muscle (LGM) and SM,7 (17.5%) places fluid collection (hematoma or effusion) in MGM and 2 (5.0%) placesin SM. There were 17 (42.5%) places that hematoma or effusion spread around the fascia of the lower leg. The diameter and thickness of hematoma or effusion are about 1.7-22.3 cm and 0.2-3.5 cm,respectively. Rupture of the GM was seen in 37 (92.5%) places,including 37 places rupture of the MGM at the myotendinous junction, 15 places rupture of the LGM at the myotendinous junction, 24 places tendonrupture of MGM,3 places tendon rupture of MGM and LGM,and 2 places tendon rupture of LGM. The maximum diameter of tendon rupture was 1.2-27.0 mm. The muscle rupture of MGM was seen in one place,and muscle rupture of MGM and LGM was seen in one place at the same time. Rupture of the SM was seen in15 (37.5%) places,including 15 places rupture of the SM at the myotendinous junction, 2 places muscle rupture of SM, 6 places tendonrupture of SM. The maximum diameter of tendon rupture was 2.5-14.9 mm. Rupture of plantaris tendon (PT) was seen in 4 (10.0%) places. Superficial vein dilatation was seen in 3 (7.5%) places. Conclusion This study shows that the rupture of the MGM at the myotendinous junction and the tendon is the main responsibility of tennis leg. Key words: Tennis legs; Gastrocnemius muscle; Plantaris tendon; Soleus muscle

Off the Courts: Occupational “Tennis Leg”

Injury to the gastrocnemius muscle (tennis leg) is a presenting complaint often associated with athletic pursuits. Despite that label, this form of injury is likely to be common to a variety of salaried and nonsalaried pursuits beyond sports. We describe the presentation and management of two cases of "tennis leg" injury occurring in an occupational rather than athletic setting and review the relevant medical literature. Partial tears of the medial insertion of the gastrocnemius tendon were documented in both cases, in the first through magnetic resonance imaging and in the second by ultrasound. Rupture of the tendon to the medial head of the gastrocnemius, the so-called "tennis leg" injury, should be considered as potentially work-related trauma, rather than taken to be solely a sports injury.

Ultrasonography Imaging for the Diagnosis and Guided Injection of Plantaris Tendon Strain in a Patient With Tennis Leg

Ultrasonography Imaging for the Diagnosis and Guided Injection of Plantaris Tendon Strain in a Patient With Tennis Leg

The third osseous ambiguous tubercle-A study on Indian population

Abstract Background &amp; Aim: Bony prominences on the medial side of the lower end of femur include the adductor tubercle and the medial epicondyle. A third osseous ambiguous tubercle or the Gastrocnemius tubercle is often noted about which there is not much mention in standard textbooks of Anatomy. This tubercle gives attachment to the medial head of gastrocnemius muscle. Its clinical relevance cannot be under estimated particularly in cases of treatment of rupture of medial head of gastrocnemius [Tennis leg] and while raising of Gastrocnemius flaps. Materials and Methods: This study was conducted in150 dry femora and in 10 dissected knee joints [Total femora 160 : 150 dry bones+ 10 cadaveric femora] gross specimens. The presence of gastrocnemius tubercle, supracondylar tubercle, the distances between gastrocnemius tubercle and adductor tubercle, medial epicondyle and condylar margin were measured. Results: The incidence of gastrocnemius tubercle was 55% and was predominantly noted on the right side [63%]. The average distance between the gastrocnemius tubercle and the adductor tubercle was 6 mm, and the average distance between the gastrocnemius tubercle and medial epicondyle was 15 mm. The incidence ofsupracondylartubercle was 71% and in 95% of the bones it was noted above the medial condylar margin. Conclusion: The awareness of the presence of gastrocnemius tubercle and supracondylar bony prominences in the medial side of lower end of femur will be of much use to the Orthopaedic surgeons and Plastic surgeons

Ultrasound Diagnosis of Calf Injuries.

Context:The medial head of the gastrocnemius is the third most commonly strained muscle in elite athletes after the biceps femoris and rectus femoris. The differential diagnosis of posterior calf injury includes musculoskeletal and nonmusculoskeletal causes. Classically, delineation of these injuries from one another relied primarily on historical features and physical examination findings. The utilization of musculoskeletal ultrasound (sonography) has augmented the diagnosis of these injuries by providing dynamic, real-time confirmation.Evidence Acquisition:A review of PubMed, OVID, and MD Consult prior to January 2016 was performed using search terms, including soleus ultrasound, gastrocnemius ultrasound, and tennis leg. The references of the pertinent articles were further reviewed for other relevant sources.Study Design:Clinical review.Level of Evidence:Level 4.Results:There have been few reviews to date of calf injuries and the use of sonography in their diagnosis. Prompt diagnosis utilizing ultrasound allows the clinician to focus management on gastrocnemius injury if present. Two-thirds of calf injuries occur at the junction of the fascia between the medial head of the gastrocnemius and the soleus. Injuries to the lateral head of the gastrocnemius occur in up to 14% of patients in some case series, but injury may occur anywhere from the proximal origin to the mid-belly to the fascial junction with the soleus. Numerous injuries to the posterior compartment can mimic gastrocnemius strain, and musculoskeletal ultrasound can aide in their diagnosis by incorporating real-time imaging into the grading of the injury and visual confirmation of physical examination findings.Conclusion:Acute injury to the posterior compartment of the lower extremity can represent a diagnostic challenge. Medial gastrocnemius strain represents the most common injury of the posterior compartment of the lower extremity. Ultrasound is a useful tool to assist the clinician in determining the specific cause of calf injury, estimate the severity of the injury, and monitor progress of healing. The vast majority of calf injuries can be diagnosed and managed without any additional imaging. Serial diagnostic ultrasound of an injured area allows for direct monitoring of tissue healing and may allow the clinician to more confidently assess response to treatment and help guide return-to-play decisions.

Literature Review “TENNIS LEG”

The tear of the gastrocnemius muscle is sometimes termed “tennis leg”, due to its frequent occurrence in younger athletes involved in the sport. This injury, however, is not limited to the athlete, and is commonly seen in middle-aged or older patients, usually over the age of 40. With a muscle tear or rupture, the patient is likely to have difficulty continuing with the sport or action. The mechanism of a gastrocnemius tear is related to the extension of the knee with simultaneous forced dorsiflexion of the ankle. In an effort to contract, the forces of the eccentric movement on the already lengthened gastrocnemius muscle lead to injury at the myotendinous junction.

An Ultrasound Pattern of Chronic Sequelae Following Medial Calf Tennis Leg Injuries

An Ultrasound Pattern of Chronic Sequelae Following Medial Calf Tennis Leg Injuries

Application of shear wave elastography for the gastrocnemius medial head to tennis leg.

Muscle strain of the gastrocnemius medial head mainly occurs at the musculotendinous junction (MTJ), and stiffness is a risk factor. Shear wave elastography (SWE) measures elasticity by determining the propagation velocity. The aim of this study was to measure the elasticity of the normal muscle and aponeurosis in the MTJ of the gastrocnemius medial head using SWE, thus obtaining information relevant to muscle strain at this point. Forty-one volunteers (82 legs) were recruited and the gastrocnemius medial heads were examined at four points: three on the aponeurosis, namely at the center of the MTJ (Central), 10 mm proximal to it (Proximal) and 10 mm distal to it (Distal); and at one on the muscle belly (Muscle). The measurements were compared among the points, between males and females, and between younger and middle-aged subjects. Correlations between the elastic modulus and age were also examined. The elastic moduli at Proximal, Central, Distal, and Muscle were 2.82 ± 0.53 m/s, 3.43 ± 0.83 m/s, 4.83 ± 1.56 m/s, and 2.25 ± 0.43 m/s, respectively. These values differed significantly among the points of the aponeurosis, Distal having the highest modulus followed by Central. The elastic moduli were significantly greater in males than females at Distal and Muscle and in younger subjects than middle-aged subjects at Muscle. No significant correlations between elastic modulus and age were observed for any point. SWE could be a feasible method for quantifying the elasticity of muscle and aponeurosis in the MTJ of the gastrocnemius medial head. Clin. Anat. 30:114-119, 2017. © 2016 Wiley Periodicals, Inc.

ULTRASONOGRAPHIC EVALUATION OF THE RUPTURED MEDIAL HEAD OF GASTROCNEMIUS MUSCLE

ABSTRACT Introduction: Tennis leg, a common injury of the medial head of gastrocnemius muscle in the muscle-tendon junction, is usually reported in men during recreational sports. Sudden pain is the main symptom accompanied by the feeling of rupture in the calf. Clinical examination followed by ultrasound is the standard diagnostic procedure. Objective: The main objectives of this study are to compare clinical and ultrasonographic findings in cases of tennis leg, evaluate the location and type of lesion in the medial head of gastrocnemius muscle, and evaluate the edema volume and the presence of deep vein thrombosis (DVT). Second, the healing process was monitored with ultrasound to distinguish the level of recovery and to record the presence of chronic sequelae. Methods: Eighty-one subjects with clinical symptoms of rupture of the medial head of gastrocnemius muscle participated in the study. A linear probe (7-12 MHz) was used for ultrasonographic (US) and a Doppler was used to verify the presence of DVT. Results: In 78 of 81 subjects examined, we found obvious US changes (96.3%) and three of them had no positive findings. In 67 of them, we diagnosed rupture of the medial head of the gastrocnemius muscle. Most of them had partial rupture (73.13%) and the remaining had total rupture (26.87%). The edema (30.84%) was found in the space between the aponeurosis of the gastrocnemius and soleus muscles. DVT with the clinical signs of tennis leg was observed in 5 of 81 patients (6.17%). Conclusion: Our findings indicate that ultrasound is very important for early diagnosis of muscle-tendon injuries in the leg. In addition, monitoring the healing process and assessing the chosen treatment showed a high efficiency. Ultrasonography is an effective method to identify and differentiate the sequelae of the injured muscles and vascular complications.

Muscular Calf Injuries in Runners.

Calf pain is a common complaint among runners of all ages but is most frequent in masters athletes. This article focuses on injuries to the triceps surae or true 'calf muscles.' The most common calf injury is a tear of the medial gastrocnemius muscle (Tennis Leg) but other structures including the lateral gastrocnemius, plantaris and soleus also may be the cause of muscular pain. This article looks at the presentation, evaluation, and treatment of these injuries. We also highlight some examples of musculoskeletal ultrasound which is a valuable tool for rapid diagnosis of the cause and extent of injury.

Tennis Leg: A Unique “Strain”, Management Approach and Review of the Literature

The term tennis leg is often used to denote any pathology resulting from acute injury to the medial head of the gastrocnemius muscle. Management of such cases is usually conservative, with scarce evidence in the literature describing cases of surgical intervention for such patients. Authors performing surgical repair, have done so for complete ruptures of the medial gastrocnemius head, usually in the acute setting. In these cases reported outcomes have been encouraging. As our imaging capabilities evolve variations in the exact pathoanatomy denoting clinic tennis leg are now emerging. We present a unique case of a linear type myotendinous tear affecting the medial head of the gastrocnemius muscle in a 45-year-old athletic patient. Following failed conservative measures, we describe an approach to management in the non-acute setting, which successfully resulted in resolution of our patient’s symptoms and return to competitive activities. We also address the evidence available within the literature regarding the management options available for tennis leg.

Tennis Leg: A Unique “Strain”, Management Approach and Review of the Literature

Tennis Leg: A Unique “Strain”, Management Approach and Review of the Literature