Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius ("Tennis Leg")

OBJECTIVE: The purpose of this study was to demonstrate the ultrasonographic (US) findings of rupture and the healing process of the medial head of the gastrocnemius ("Tennis Leg"). MATERIALS AND METHODS: Twenty-two patients (age range: 30 to 45 years) with clinically suspected ruptures of the medial head of the gastrocnemius were referred to us for US examination. All the patients underwent US of the affected limb and the contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients were performed at two-week intervals during the month after injury and at one-month intervals during the following six months. RESULTS: Of the 22 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in seven patients (31.8%); the remaining 15 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 20 patients (90.9%). The thickness of the fluid collection, including the hematoma in the patients with complete rupture (mean: 9.7 mm), was significantly greater than that seen in the patients with partial tear (mean: 6.8 mm) (p < 0.01). The primary union of the medial head of the gastrocnemius with the soleus muscle in all the patients with muscle rupture and fluid collection was recognized via the hypoechoic tissue after four weeks. CONCLUSION: Ultrasonography is a useful imaging modality for the diagnosis and follow-up examination for the patients suffering with rupture of the medial head of the gastrocnemius.

Emergency femoral arteriography in lower limb vascular trauma.

There are difficulties in obtaining emergency arteriographic evaluation in lower limb vascular trauma even in the best centres in the world. Ten emergency room arteriograms were performed at the new Accident Service of the General Hospital, Colombo from February to October 1992 by the vascular team, using a venous cannula and improvised tubing systems. The indications were, absence of distal pulses with closed injury to the limb, previous attempts at repair, injury to the limb at more than one site and multiple shrapnel injury. A traumatic arteriovenous communication was shown in one of the arteriograms. Unnecessary exploration of the artery was prevented by the demonstration of a patent femoropopliteal segment in two cases. The average delay caused by this procedure was less than one hour, which compares well with centres in the West. Provision of an arteriogram kit at the Accident Service will help to overcome practical problems.