Gastrocnemius Strain - Tennis

Abstract

HISTORY: A 51-year-old male experienced a left medial head gastrocnemius musculotendinous junction (MTJ) strain during a recreational tennis competition. He was switching lateral directions quickly and felt a burning sensation, then a pull accompanied with an audible pop in his left gastrocnemius along the distal MTJ. He developed immediate gastrocnemius muscle pain and a limp. While the pain was gradually improving over this time period, he reported to our department two weeks post injury. He complained of 3/10 dull aching pain that was worse with activity and improved with rest. He had marked improvement for the first two weeks of physical therapy. However, following a deep tissue massage by a physical therapist two days prior, he returned complaining of acutely worsening pain and swelling since the massage. The patient indicated the only difference in activity or therapy was the deep tissue massage and his pain worsened acutely post-massage. PHYSICAL EXAMINATION: Initial physical examination revealed mild tenderness to palpation over the medial head of the gastrocnemius at the MTJ in the left lower extremity. Remainder of his exam was unremarkable. Patient was diagnosed with a left gastrocnemius MTJ strain, consistent with the clinical condition known as tennis leg (TL). The patient presented with an initial Well's score of -1, however following his deep tissue massage, the score was +3. His exam showed increased pain, swelling, and inability to weight bear on the affected side. DIFFERENTIAL DIAGNOSIS: Medial head gastrocnemius strain (Tennis leg) Deep vein thrombosis Achilles tendon rupture TEST AND RESULTS: Duplex venous external Doppler ultrasound - Diffuse intraluminal echoes within the popliteal vein extending into the tibioperoneal trunk compatible with deep vein thromboses Chest radiograph - unremarkable with no infiltrates FINAL WORKING DIAGNOSIS: Acute gastrocnemius strain complicated by DVT TREATMENT AND OUTCOMES: 1. Timely recognition and management 2. Patient was placed on enoxaparin 80 mg injected subcutaneously twice daily for 10 days and 7.5 mg of warfarin on alternate days and 10 mg all other days to be adjusted per coagulation studies performed weekly. 3. Follow-up by both sports and vascular medicine departments 4. Returned to activities with no additional complications

The authors' abstract, as published at the source. Medicine & Science in Sports & Exercise, 2009 · DOI ↗