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Medial Gastrocnemius Strain Clinical Presentation

  • Author: Anthony J Saglimbeni, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Oct 27, 2015
 

History

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  • An audible pop when the injury to the medial calf occurred is usually reported, and the patient complains of feeling like a stick struck his/her calf.
  • The patient complains of pain in the area of the calf, which also radiates to the knee or the ankle. In addition, the patient complains of pain with range of motion (ROM) of the ankle.
  • The patient complains of a swollen leg that extends down to the foot or ankle, as well as the associated color changes of bruising. (See also the Medscape Reference article Contusions.)
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Physical

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  • Inspection
    • Asymmetric calf swelling and discoloration, potentially spreading to the ankle and foot, is noted on physical examination.
    • If the stage of swelling has resolved, a visible defect in the medial gastrocnemius muscle may be evident.
  • Palpation
    • Tenderness is noted upon palpation in the entire medial gastrocnemius muscle, but this tenderness is observed to be exquisitely more painful at the medial musculotendinous junction.
    • Depending on the degree of swelling, a palpable defect may be evident at the medial musculotendinous junction; however, with extreme swelling, this finding may not be appreciable.
    • Palpation of the Achilles tendon should demonstrate an intact tendon.
    • The peripheral pulses should be present and symmetric.
  • Provocative maneuvers: Moderate to severe pain is demonstrated with passive ankle dorsiflexion (due to stretching of the torn muscle fibers), as well as with active resistance to ankle plantar flexion (due to the firing of the torn muscle fibers).
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Causes

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  • Age/activity status: As indicated in the Background section, medial calf injuries occur more commonly in the middle-aged recreational athlete. This population typically continues to be physically active at a moderate to high intensity but not on a regular basis, and these individuals are also likely to have maintained a moderate degree of the muscle mass from their more active days. Yet weekend warriors seem to have started to lose some of the flexibility they had when they were younger, resulting in a relatively large gastrocnemius muscle that is less flexible than it had been, and on occasion, the muscle is challenged with a ballistic or explosive force, leading to a partial or complete rupture.
  • Deconditioned/unstretched muscles: The cold and unstretched muscles that recreational athletes often use to compete with are very likely to rupture when challenged compared with conditioned and stretched muscles. However, because medial calf injuries also occur in the physically fit, the role of stretching in prevention is not completely understood. This phenomenon may mean that force versus elasticity is the key formula, and if the force overcomes the elasticity, even in a conditioned athlete, then a rupture or injury can occur.
  • Previous injury: The athlete with recurrent calf strains is likely to have healed with fibrotic scar tissue, which absorbs forces differently and is thus more likely to result in rupture when the muscle is challenged.
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Contributor Information and Disclosures
Author

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

References
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  14. Madeleine P, Hoej BP, Fernández-de-Las-Peñas C, Rathleff MS, Kaalund S. Pressure pain sensitivity changes after use of shock-absorbing insoles among young soccer players training on artificial turf: a randomized controlled trial. J Orthop Sports Phys Ther. 2014 Aug. 44(8):587-94. [Medline].

  15. Abellaneda S, Guissard N, Duchateau J. The relative lengthening of the myotendinous structures in the medial gastrocnemius during passive stretching differs among individuals. J Appl Physiol. 2009 Jan. 106(1):169-77. [Medline].

  16. Shin DD, Hodgson JA, Edgerton VR, Sinha S. In vivo intramuscular fascicle-aponeuroses dynamics of the human medial gastrocnemius during plantarflexion and dorsiflextion of the foot. J Appl Physiol. 2009 Jul 16. epub ahead of print. [Medline]. [Full Text].

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