Fact-sheet: Gastrocnemius soleus disinsertion
Updated on 11/21/2021 at 6:03 PM
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Definition
Mechanical muscle injury occurring at the myotendinous junction, the weak point of the muscle-tendon unit, triggered by excessive stretching or a sudden contraction of the muscle: typically an intrinsic mechanism occurring during eccentric contraction.
Muscles most commonly affected: rectus femoris, medial gastrocnemius, hamstrings
Athletes +++
Clinical features
- Sudden pain at the affected site
- Variable functional impairment
Ultrasound
Example of myotendinous disruption of the medial gastrocnemius muscle ("tennis leg"):
- ill-defined hyperechoic appearance of the myotendinous junction, starting at the distal aspect of the muscle, with loss of its triangular shape on sagittal images
- hypoechoic cleavage plane between the aponeuroses of the medial gastrocnemius and soleus muscles, with formation of a hematoma
MRI
- Ill-defined T2 hyperintensity of the affected muscle region, adjacent to an aponeurotic septum
- Hematoma with marked T2 hyperintensity, of variable size, between the medial gastrocnemius and soleus muscles
Management
In tennis leg (myotendinous disruption of the gastrocnemius), if a hematoma is anechoic, compressible, and >3 mL:
- ultrasound-guided evacuation puncture
- + prescription of a class 2 compression stocking to be worn day and night
Differential diagnosis
- Achilles tendon rupture
- Calf deep vein thrombosis