Proximal Injury

Injury to the proximal myotendinous junction of gastrocnemius posterior to the knee can occur but is an unusual clinical entity and the imaging appearance is rarely reported [112]. The clinical significance of proximal injuries is also unclear aside from localization of pain to the knee instead of the mid calf, which can alter the differential diagnosis. If no abnormality exits on MRI, one should consider referred pain related to lower lumbar disc pathology (ie, L5 level). In children and adolescents some types of ''cortical desmoid'' or metaphyseal cortical defects in asymptomatic individual are seen at the gastrocnemius insertion

Medial Gastrocnemius Ultrasound
Fig. 25. Intermuscular fluid collection between medial gastrocnemius and soleus muscle on ultrasound (arrows) in a patient clinically with tennis leg.

on MRI and are thought to be related to chronic avulsive injury and must be distinguished from tumor [113].

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