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Medial Gastrocnemius Strain Differential Diagnoses

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

Diagnostic Considerations

The following conditions can be confused with a gastrocnemius strain:

Baker cyst rupture

Deep venous thrombosis

Plantaris tendon rupture

Acute compartment syndrome after rupture of the medial head of the gastrocnemius

Chronic exertional compartment syndrome (posterior)

Posterior tibial tendon rupture or tendinitis

Popliteal artery entrapment syndrome

Anomalous gastrocnemius muscle rupture

A Baker cyst is a reactive outpouching of the knee joint capsule. The presence of a Baker cyst implies chronic internal knee pathology, often arthritic in nature, but it may also include traumatic meniscal pathology. The cyst is usually painless but often cosmetically unacceptable to the patient. If the Baker cyst ruptures, the leg swells, and the pain is diffuse. This condition can be confused with a ruptured gastrocnemius muscle.

(See also the Medscape Reference articles Baker Cyst [in the Radiology section], Knee Injury, Soft Tissue [in the Emergency Medicine section], and Cystic Lesions About the Knee and Limping Child [in the Orthopedic Surgery section].)

A femoral or popliteal deep venous thrombosis (DVT) can cause leg swelling, which can result in leg pain. If this condition occurs in the same time frame as an acute leg injury, the 2 conditions can be confused.

(See also the Medscape Reference articles Deep Venous Thrombosis and Thrombophlebitis [in the Emergency Medicine section] and Deep Venous Thrombosis, Lower Extremity [in the Radiology section].)

The plantaris tendon originates in the popliteal area, and this tendon is also a plantar flexor of the ankle. If the plantaris tendon ruptures, the leg swells, and the resulting tenderness can be in the same area as where a gastrocnemius strain would occur.

Achilles tendon injury can occur with the identical mechanism of a medial gastrocnemius rupture. Because the ensuing fluid and edema may migrate proximally, the 2 conditions may mimic each other. An Achilles tendon rupture results in an inability to plantar flex the foot, and a more distal defect of the tendon is usually palpable. A Thompson test can be used to differentiate the 2 injuries. The test is performed with the patient prone and the knee held in flexion. Then, the gastrocnemius muscle is squeezed. A negative sign results in normal plantar flexion of the foot and ankle. If the flexion is not appreciated, the test is positive and due to a disrupted Achilles tendon. (See also the Medscape Reference article Achilles Tendon Rupture.)

Acute compartment syndrome of the lower extremity occurs after trauma, with accumulation of blood or fluid in a closed compartment of the leg. The resultant pressure produces pain and swelling, and if the posterior compartment is affected, this could clinically present similarly to a medial gastrocnemius tear. A case study by Tao et al recommends that clinicians should have a high index of suspicion for atraumatic compartment syndrome, and timely surgical fasciotomy must be undertaken to avoid complications resulting from delayed diagnosis and treatment.[8]

(See also the Medscape Reference articles Compartment Syndrome, Lower Extremity [in the Orthopedic Surgery section], Compartment Syndrome [in the Physical Medicine and Rehabilitation section], and Compartment Syndrome, Extremity [in the Emergency Medicine section].)

Chronic compartment syndrome results in affected individuals after a degree of exertion and from vascular compromise with edema in the compartment of the leg. The pain that ensues can mimic that of gastrocnemius muscle strains, but this condition becomes symptom-free after the exertion is completed. (See also the Medscape Reference article Compartment Syndromes [in the Sports Medicine section].)

The popliteal tendon courses posteriorly on the medial side of the leg. Injuries to this structure can distribute pain in the same regions as a tennis leg injury. (See also the Medscape Reference articles Pes Planus [in the Orthopedic Surgery section] and Athletic Foot Injuries [in the Sports Medicine section].)

The popliteal artery may be entrapped during its course in the leg. The most common cause is an anomalous gastrocnemius muscle. Typically, popliteal artery entrapment manifests during exertion, and the symptoms of this condition are more consistent with the symptoms of chronic exertional compartment syndrome.

(See also the Medscape Reference articles Peripheral Arterial Occlusive Disease [in the Vascular Surgery section], Compartment Syndrome, Lower Extremity [in the Orthopedic Surgery section], and Compartment Syndromes [in the Sports Medicine section].)

Differential Diagnoses

Contributor Information and Disclosures

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.

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