Tennis

The term ''tennis leg'' has been used to describe muscle injury and pain in the calf. The term is attributed to the tennis serving motion of fully extending the knee with sudden ankle dorsiflexion invoking maximal stretch on the calf.

Avulsion Lesser Trochanter
Fig. 22. Sports-related traumatic avulsion of the lesser trochanter in a 15-year-old track athlete (A). Avulsion of lesser trochanter in an adult without significant history of injury (B). MRI in the same adult shows focal metastatic disease (C).

Fig. 23. Axial image showing increased fluid signal in the proximal lateral gastrocnemius consistent with a mild strain although the location is somewhat atypical (arrow).

Muscular Veins Gastrocnemius

Fig. 24. Axial T2 sequences of a calf showing diffuse mild edema of posterior muscles in a patient thought to have a muscle strain (A). Note filling defects of popliteal branch vessels as compared with opposite side. White arrows demonstrate vicinity where one could look for black dots representing clot in the veins. Patient eventually developed shortness of breath and was found to have a pulmonary embolism filling defect (arrow shows thrombus in a pulmonary artery) seen on CT angiography treated successfully (B).

Fig. 24. Axial T2 sequences of a calf showing diffuse mild edema of posterior muscles in a patient thought to have a muscle strain (A). Note filling defects of popliteal branch vessels as compared with opposite side. White arrows demonstrate vicinity where one could look for black dots representing clot in the veins. Patient eventually developed shortness of breath and was found to have a pulmonary embolism filling defect (arrow shows thrombus in a pulmonary artery) seen on CT angiography treated successfully (B).

However, this injury has been described in young athletes during periods of heavy exercise (such as basketball, running, or severe stretching) and in more elderly patients who may simply be stepping out of a car or getting out of bed [104,108]. Patients will experience sudden onset of pain with focal swelling and ecchymosis of the calf. Tennis leg typically refers to injury of the distal myotendinous junction, although proximal myotendinous injury may occur. In an ultrasound study of 141 patients with tennis leg 67% showed partial tear of medial gastrocnemius, 1.4% were associated with plantaris tendon rupture, and 21% had intermuscular fluid collection without muscle tear of the medial gastrocnemius (Fig. 25). Importantly, 10% had DVT without other findings and it was associated finding in another 5% [106].

Treatment of most gastrocnemius injuries is usually conservative. Occasionally, surgery may be performed to evacuate a hematoma, to repair a grade III injury or to perform surgical decompression in the case of compartment syndrome [109]. One case report describes surgical release of the sural nerve in a patient with sensory loss as the sural nerve was entrapped within scar tissue beneath the deep fascia of the gastrocnemius from remote injury [110]. Tennis leg can be associated with acute compartment syndrome as well [111].

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