Tennis leg

The term 'tennis leg' is used for a partial rupture of the medial head of the gastrocnemius muscle, not to be clinically confused with a tear of the plantaris tendon [1]. Often the tear occurs at the musculotendinous junction. The injury occurs most frequently during running, jumping or ball games and usually results from an eccentric load placed across the ankle with the knee in extension. The injury mechanism is thus indi rect, but the patient may describe a direct trauma to the calf region, such as a kick or hit by the ball or bat to the calf. In physical examination of the painful calf swelling can be seen. A maximal point of tenderness with a palpable defect in the medial head of the gastrocnemius muscle can be recognized at examination. Ankle plantar flexion is weakened and painful. Sometimes deep venous thrombosis may exist simultaneously.

Ultrasonographic or venographic investigation can be performed to establish the diagnosis and to exclude deep venous thrombosis. With MRI the location and extent of muscle injury can be visualized.

Treatment of the tennis leg is non-surgical, including elevation, ice, compressive wrapping and partial weight-bearing. Heel lifts in the shoes may be used during the first week. A progressive calf stretching and strengthening program is undertaken as pain and swelling resolve. Usually full recovery occurs in a few weeks. However, some of the ruptures are so large that a permanent defect and muscle weakness remains. However, the results of late repair of the musculo-tendinous defect are not good, and operative treatment should be avoided.

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