Medial Gastrocnemius Strain 

  • Author: Anthony J Saglimbeni, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Dec 14, 2011
 

Background

A medial calf injury is a musculotendinous disruption of varying degrees in the medial head of the gastrocnemius muscle that results from an acute, forceful push-off with the foot.[1, 2, 3, 4, 5, 6] This injury occurs commonly in sports activities (eg, hill running, jumping, tennis), but it can occur in any activity. A medial calf injury is often seen in the intermittently active athlete, often referred to as the "weekend warrior."

This condition has been termed "tennis leg" because of its prevalence in this particular sport, but medial calf injury can happen in a variety of sports or other activities. One mechanism that occurs is on the back leg during a lunging shot, in which the knee is extended while the foot is dorsiflexed. This action puts maximal tension on the gastrocnemius muscle as the lengthened muscle is contracted at the "push off," resulting in a medial calf injury. (See also the eMedicine article Body Contouring, Calf Augmentation.)

An unusual presentation of a medial gastrocnemius injury during namaz praying was reported by Yilmaz et al, who performed a retrospective study of the sonographic and magnetic resonance image (MRI) findings of patients referred over 7 years with leg pain and swelling.[7] Of 543 patients, 14 had a final diagnosis of medial gastrocnemius rupture that occurred during namaz praying. Nine of 14 (64.2%) patients had incomplete tears at the musculotendinous junction, and 5 of 14 (35.8%) patients had partial tears.

The diagnosis in 4 of 14 (28.6%) patients was misattributed to deep vein thrombosis due to clinical findings and presentation, associated fluid collection between the gastrocnemius and soleus muscles was found in 11 of 14 (78.5%) patients, and isolated fluid collection between the gastrocnemius and soleus muscles was seen in 1 patient.[7] The investigators suggested ultrasonography and MRI can be used to correctly diagnose patients with medial gastrocnemius injuries.

For excellent patient education resources, visit eMedicine's Sports Injury Center and Sprains and Strains Center. Also, see eMedicine's patient education articles Muscle Strain and Sprains and Strains.

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Epidemiology

Frequency

International

Medial calf injuries occur more commonly in men than in women, and these injuries usually afflict athletes and others in the fourth to sixth decade of life. Medial calf injuries are most commonly seen acutely, but up to 20% of affected patients report a prodrome of calf tightness several days before the injury, thus suggesting a potential chronic predisposition.

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Functional Anatomy

The medial head of the gastrocnemius muscle originates from the posterior aspect of the medial femoral condyle, and as it courses distally, the medial head merges with the lateral head of the gastrocnemius. Further distally, the joined heads of the gastrocnemius merge with the soleus muscle-tendon complex to form the Achilles tendon. The main function of the gastrocnemius muscle is to plantar flex the ankle, but it also provides some knee flexion, as well as contributes to the posterior stability of the knee and partially to the motion of the menisci with flexion/extension of the knee. Throughout the belly of the muscle, the medial gastrocnemius has several origins of tendinous formation. Most strains occur at this musculotendinous junction.

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Sport-Specific Biomechanics

The medial calf injury usually occurs when an eccentric force is applied to the gastrocnemius muscle, which usually happens when the knee is extended, the ankle is dorsiflexed, and the gastrocnemius attempts to contract in the already lengthened state.[1, 2, 3, 4, 5, 6] This is the common position of the back leg in a tennis stroke, and it results in the greatest force to the muscle unit; but medial calf injuries can also occur during a typical contraction of ankle plantar flexion, especially if the athlete is pushing or lifting a large weight or force.

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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 and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

Specialty Editor Board

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

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, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

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, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References
  1. Brown DE. Ankle and leg injuries. In: Walsh W, Shelton GL, eds. The Team Physician's Handbook. Vol 1. Philadelphia, Pa: Hanley & Belfus; 1990:448-9.

  2. Canale T, ed. Campbell's Operative Orthopaedics. 8th ed. St. Louis, Mo: Mosby; 1998:1413-25.

  3. Glazer JL, Hosey RG. Soft-tissue injuries of the lower extremity. Prim Care. Dec 2004;31(4):1005-24. [Medline].

  4. Johnson MD. Physiology of musculoskeletal growth. In: Sallis RE, Massimino R, eds. ACSM's Essentials of Sports Medicine. Vol 1. St. Louis, Mo: Mosby; 1997:534-8.

  5. Pedowitz R, Saglimbeni A. The leg. In: Safran MR, McKeag DB, Van Camp SP, eds. Manual of Sports Medicine. Vol 1. Philadelphia, Pa: Lippincott-Raven; 1998:460-6.

  6. Taunton J, Smith C, Magee DJ. Leg, foot and ankle injuries. Athletic Injuries and Rehabilitation. Vol 1. Philadelphia, Pa: WB Saunders Co; 1996:730-6.

  7. Yilmaz C, Orgenc Y, Ergenc R, Erkan N. Rupture of the medial gastrocnemius muscle during namaz praying: an unusual cause of tennis leg. Comput Med Imaging Graph. Dec 2008;32(8):728-31. [Medline].

  8. Darby J, Hodson-Tole EF, Costen N, Loram ID. Automated Regional Analysis of B-Mode Ultrasound Images of Skeletal Muscle Movement. J Appl Physiol. Oct 27 2011;[Medline].

  9. Lindberg F, Öhberg F, Granåsen G, Brodin LÅ, Grönlund C. Pennation angle dependency in skeletal muscle tissue doppler strain in dynamic contractions. Ultrasound Med Biol. Jul 2011;37(7):1151-60. [Medline].

  10. Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh EC. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol. Oct 2007;36(10):921-7. [Medline].

  11. Legome E, Pancu D. Future applications for emergency ultrasound. Emerg Med Clin North Am. Aug 2004;22(3):817-27. [Medline].

  12. Kwak HS, Han YM, Lee SY, Kim KN, Chung GH. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius ("tennis leg"). Korean J Radiol. Jul-Sep 2006;7(3):193-8. [Medline]. [Full Text].

  13. 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. Jan 2009;106(1):169-77. [Medline].

  14. 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. Jul 16 2009;epub ahead of print. [Medline].

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