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Medial Gastrocnemius Strain

Practice Essentials

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.
 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 Medscape Reference article 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.
 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.
 The investigators suggested ultrasonography and MRI can be used to correctly diagnose patients with medial gastrocnemius injuries.

For excellent patient education resources, visit eMedicineHealth’s First Aid and Injuries Center. Also, see eMedicineHealth’s patient education articles Muscle Strain and Sprains and Strains.

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