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A novel approach to sonographic examination in a patient with a calf muscle tear: a case report

DOI: 10.4076/1752-1947-3-7291

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A 60-year-old man in good health visited our rehabilitation clinic complaining of left calf muscle pain. On suspicion of a ruptured left medial head gastrocnemius muscle, a soft tissue ultrasound examination was performed. An ultrasound examination revealed symmetrical findings of bilateral calf muscles without evidence of muscle rupture. A roentgenogram of the left lower limb did not reveal any bony lesions. An ultrasound examination one week later also revealed negative sonographic findings. However, he still complained of persistent pain in his left calf area. A different ultrasound examination approach was then performed with the patient lying in the supine position with his knee flexed at 90 degrees. The transducer was then placed pointing upwards to examine the muscles and well-defined anechoic fluid collections with areas of hypoechoic surroundings were observed.For patients suffering from calf muscle area pain and suspicion of tennis leg, a soft tissue ultrasound is a simple tool to confirm the diagnosis. However, in the case of negative sonographic findings, we recommend trying a different positional approach to examine the calf muscles by ultrasound before the diagnosis of tennis leg can be ruled out.Rupture of the distal musculotendinous junction at the medial head of the gastrocnemius muscle is known as "tennis leg" [1,2]. The occurrence of tennis leg is relatively common in athletes who perform sudden acceleration and deceleration maneuvers. The classic clinical manifestation of tennis leg is that of a middle-aged person who complains of acute sports-related pain in the middle portion of the calf muscle associated with a snapping sensation [3]. Imaging tools such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) can be used for the diagnosis of tennis leg. Presently, US is most economical and has been used as the primary imaging technique for evaluating patients suffering from tennis leg and other muscle ruptures [1,4].Wh


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