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Longitudinal US images of the medial head of the gastrocnemius muscle (G) and soleus (S) muscle. The patient was examined in the prone position.
Source publication
Rupture of the distal musculotendinous junction of the medial head of the gastrocnemius, also known as "tennis leg", can be readily examined using a soft tissue ultrasound. Loss of muscle fiber continuity and the occurrence of bloody fluid accumulation can be observed using ultrasound with the patient in the prone position; however, some cases may...
Context in source publication
Context 1
... using US to examine patients suspected of having calf muscle strains, patients are usually placed in the prone position for better viewing of the longitudinal and transverse muscle planes ( Figure 1) [1]. Under US, rupture of the medial head of the gastrocnemius muscle can be observed as partial discontinuity of the muscle fibers or as a hyperechoic fluid collection between the gastrocnemius and soleus muscles [1,2]. ...Citations
... The prone position is the most common position while performing the ultrasonic examination of the posterior muscles of the lower limbs (including the GM) because this position allows better observation of the longitudinal and transverse muscle planes (16,18,(20)(21)(22). However, in clinical practice, we have observed that a few older adults with disability fail to complete the examination in the prone position, and hence, in such cases, the sonographer has to perform the examination with patients acquiring other postures. ...
Objective
This study aimed to investigate the accuracy and consistency of different ultrasound protocols for the measurement of gastrocnemius muscle (GM) thickness and to identify a suitable ultrasound scheme that can be used to detect the low muscle mass in older with disability.
Materials and methods
In this cross-sectional study, each participant underwent three different ultrasound protocols for the measurement of the GM thickness, and each measurement was repeated three times. The three measurement schemes were as follows: method A, lying on the examination bed in a prone position with legs stretched and relaxed and feet hanging outside the examination bed; method B, lateral right side lying position with legs separated (left leg flexed and right leg in a relaxed state); and method C, right side lying position with legs together and lower limb muscles in a relaxed state. The low muscle mass was determined by averaging two or three measurements of the GM thickness determined using different sonographic protocols.
Results
The study included 489 participants. The difference in the prevalence of low muscle mass identified between two and three replicates of the same measurement protocol ranged from 0 to 1.3%. Considering the three repeated measurements of the method A as the reference, the area under the curve (AUC) in different measurement schemes were 0.977-1 and 0.973-1 in males and females, respectively. Furthermore, male and female Kappa values from low to high were 0.773, 0.801, 0.829, 0.839, and 0.967 and 0.786, 0.794, 0.804, 0.819, and 0.984, respectively.
Conclusion
Different ultrasound measurement protocols showed high accuracy and consistency in identifying low muscle mass. Repeating the measurements two or three times was found to be feasible.
... One might consider a diagnosis of a rupture of the distal musculotendinous junction of the medial head of the gastrocnemius muscle (tennis leg). This condition is often seen in athletes performing sudden acceleration and deceleration manoeuvres [10]. The patient denied any history of trauma, and the physical examination revealed localised pain at the medial aspect of the upper left leg. ...
Pancoast tumours (PTs) are apical tumours of the lung that manifest with a variety of symptoms. Herein, we describe a rare case of a 56-year-old female with a one-month history of persistent left leg pain despite advanced imaging, such as magnetic resonance imaging (MRI), and orthopaedic input, which was focused onto her left knee being the prime cause of her pain. Her non-resolving symptoms prompted her to attend the Emergency Department. A careful clinical examination pointed towards the left proximal tibia being the most probable cause. Basic radiographic imaging (x-ray) of the left tibia revealed a lytic lesion which was later confirmed to be metastatic disease arising from a Pancoast tumour (PT) following further advanced imaging and diagnostics. This case highlights a unique presentation of a Pancoast tumour that, to our knowledge, has never been reported before in the medical literature. A high index of suspicion, careful examination, and investigation were essential to reach this diagnosis.
... Studies utilizing MRI, sonography, or surgical exploration show that plantaris injuries may occur in isolation or concomitantly with tears of the gastrocnemius, soleus, or popliteus, 4,7,15,22,27,37,63 but prolific edema can make the precise identification of the involved structures difficult. Magnetic resonance imaging studies suggest that the diagnosis of plantaris strain is appropriate when fluid is observed with a strong clinical suspicion, even when no tear is initially seen. ...
... Nonsurgical treatment is typically administered for 3 to 16 weeks, particularly when there is involvement of the gastrocsoleus complex. 7,24,25 While immobilization is indicated during the acute phase of muscle healing due to histological factors such as capillary growth, granulation tissue formation, muscle fiber regeneration, and biomechanical tensile strength development, these factors have more precedence when healing, repair, and tissue regeneration are the goals. 30,38,39 In this case, immobilization, protected weight bearing, and edema-control strategies were implemented, with the aim to improve function by decreasing pain, inflammation, and muscle soreness; however, as the likelihood of an isolated plantaris rupture increased and the suspicion of a medial gastrocsoleus strain diminished, it was recognized that rehabilitation should focus on treating the objective clinical symptoms and on functional ability, because healing of the tendon was not the aim. ...
... Other cases report patient progression to graduated strengthening, stretching, and proprioceptive activities. 5,7,8,13,24,47 This athlete could advance to more dynamic activities without incident, and he demonstrated the ability to generate adequate forces to participate in oncourt activities that included running and double-and single-leg jumping, without apparent proprioceptive deficit. There is no consensus on guidelines or criteria for return to play for muscle strains, and decision making is based on expert opinion and related to the desire to minimize the risk of recurrence and maximize performance. ...
Study Design Case report. Background Acute injuries of the triceps surae and Achilles tendon are common in sports. Rupture of the plantaris tendon can be challenging to diagnose. There is limited evidence detailing the diagnosis, rehabilitation, and accelerated return to sport of elite professional basketball players who have suffered calf injuries. Case Description A 25-year-old male professional basketball player sustained injury to his calf during a professional basketball game. This case report details the presumptive diagnosis, graduated progression of intervention, and return to play of a professional sports person with a likely isolated plantaris tendon tear. Outcomes The patient returned to post season competition 10-days post injury. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Before returning to play the athlete showed improvements beyond the minimal clinically important difference for ankle girth (2 cm) and Numeric Pain Rating (4 points, scale 0-10). Functional testing was conducted that included the Y-Balance Lower Quarter test and the Functional Movement Screen with results that exceeded or returned the athlete to pre-season levels. Discussion This report demonstrates a case where a professional basketball player returned to competitive play in an accelerated time frame following injury to his calf. Diagnosing a plantaris tendon rupture can be challenging, and anatomical variations of this muscle should be considered. It was demonstrated in this case that physical therapy (PT) rehabilitation was helpful in making a treatment based clinical diagnosis when imaging was unclear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther, Epub 6 Apr 2018. doi:10.2519/jospt.2018.7192.
... Tearing of the muscle-tendon complex (MTC) is a common sports-related injury (Bianchi et al., 1998). Muscles are more prone to tear while doing eccentric exercises in which muscle contraction is combined with excessive stretching (Petilon et al., 2005, Bianchi et al., 2006, Chen et al., 2009, Uchiyama et al., 2011. Following a tear of a muscle, functional impairment occurs as the result of the alteration of the MTC's mechanical properties. ...
The muscle-tendon complex (MTC) is a multi-scale, anisotropic, non-homogeneous structure. It is composed of fascicles, gathered together in a conjunctive aponeurosis. Fibers are oriented into the MTC with a pennation angle. Many MTC models use the Finite Element Method (FEM) to simulate the behavior of the MTC as a hyper-viscoelastic material. The Discrete Element Method (DEM) could be adapted to model fibrous materials, such as the MTC. DEM could capture the complex behavior of a material with a simple discretization scheme and help in understanding the influence of the orientation of fibers on the MTC׳s behavior. The aims of this study were to model the MTC in DEM at the macroscopic scale and to obtain the force/displacement curve during a non-destructive passive tensile test. Another aim was to highlight the influence of the geometrical parameters of the MTC on the global mechanical behavior. A geometrical construction of the MTC was done using discrete element linked by springs. Young׳s modulus values of the MTC׳s components were retrieved from the literature to model the microscopic stiffness of each spring. Alignment and re-orientation of all of the muscle׳s fibers with the tensile axis were observed numerically. The hyper-elastic behavior of the MTC was pointed out. The structure׳s effects, added to the geometrical parameters, highlight the MTC׳s mechanical behavior. It is also highlighted by the heterogeneity of the strain of the MTC׳s components. DEM seems to be a promising method to model the hyper-elastic macroscopic behavior of the MTC with simple elastic microscopic elements.
The use of ultrasonography in interventional pain management for both diagnostic and therapeutic purposes has revolutionized pain management in modern times. Accessibility, reduced cost, high resolution imaging of soft tissues, joints, tendons and ligaments in real time and dynamic patient examination has made ultrasonography an attractive option to pain physicians. The ability to perform procedures at patient’s bedside without concerns of radiation exposure has made the use of ultrasonography a necessity in the interventional pain world. We should continue to highlight the important role of fluoroscopic guided procedure for patient pain management.
The tearing of the muscle-tendon complex (MTC) is one of the common sports-related injuries. A better understanding of the mechanisms of rupture and its location could help clinicians improve the way they manage the rehabilitation period of patients. A new numerical approach using the discrete element method (DEM) may be an appropriate approach, as it considers the architecture and the complex behavior of the MTC. The aims of this study were therefore: first, to model and investigate the mechanical elongation response of the MTC until rupture with muscular activation. Secondly, to compare results with experimental data, ex vivo tensile tests until rupture were done on human cadavers {triceps surae muscle + Achilles tendon}. Force/displacement curves and patterns of rupture were analyzed. A numerical model of the MTC was completed in DEM. In both numerical and experimental data, rupture appeared at the myotendinous junction (MTJ). Moreover, force/displacement curves and global rupture strain were in agreement between both studies. The order of magnitude of rupture force was close between numerical (858 N for passive rupture and 996 N-1032 N for rupture with muscular activation) and experimental tests (622 N ± 273 N) as for the displacement of the beginning of rupture (numerical: 28-29 mm, experimental: 31.9 mm ± 3.6 mm). These differences could be explained by choices of DEM model and mechanical properties of MTC's components or their rupture strain values. Here we show that he MTC was broken by fibers' delamination at the distal MTJ and by tendon disinsertion at the proximal MTJ in agreement with experimental data and literature.
