1
|
Domeracki SJ, Landman Z, Blanc PD, Guntur S. Off the Courts: Occupational “Tennis Leg”. Workplace Health Saf 2018; 67:5-8. [DOI: 10.1177/2165079918786294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Injury to the gastrocnemius muscle (tennis leg) is a presenting complaint often associated with athletic pursuits. Despite that label, this form of injury is likely to be common to a variety of salaried and nonsalaried pursuits beyond sports. Method: We describe the presentation and management of two cases of “tennis leg” injury occurring in an occupational rather than athletic setting and review the relevant medical literature. Results: Partial tears of the medial insertion of the gastrocnemius tendon were documented in both cases, in the first through magnetic resonance imaging and in the second by ultrasound. Conclusion: Rupture of the tendon to the medial head of the gastrocnemius, the so-called “tennis leg” injury, should be considered as potentially work-related trauma, rather than taken to be solely a sports injury.
Collapse
Affiliation(s)
- Sandra J. Domeracki
- University of California, San Francisco
- San Francisco Veterans Affairs Health Care System
| | | | - Paul D. Blanc
- University of California, San Francisco
- San Francisco Veterans Affairs Health Care System
| | - Sandeep Guntur
- University of California, San Francisco
- San Francisco Veterans Affairs Health Care System
| |
Collapse
|
2
|
Borrione P, Fossati C, Pereira MT, Giannini S, Davico M, Minganti C, Pigozzi F. The use of platelet-rich plasma (PRP) in the treatment of gastrocnemius strains: a retrospective observational study. Platelets 2017; 29:596-601. [DOI: 10.1080/09537104.2017.1349307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paolo Borrione
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy
- Department for Health and Performance, Regional Antidoping and Toxicology Center, Orbassano, TO, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | | | - Silvana Giannini
- Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy
| | - Marco Davico
- Department for Health and Performance, Regional Antidoping and Toxicology Center, Orbassano, TO, Italy
| | - Carlo Minganti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy
| |
Collapse
|
3
|
Abstract
Sports injuries in children affect both growing bone and soft tissues, and can result in damage of growth mechanisms with subsequent lifelong growth disturbance. During growth, there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in childhood, fractures that initially united with some deformity can completely remodel, and the bone may appear totally normal in later life. Most injuries in children’s sports are minor and self-limiting, suggesting that children and youth sports are safe. However, as the risk of injuries sustained by young athletes can be significant, training programmes should take into account their physical and psychological immaturity, so that growing athletes can adjust to their own body’s changes.
Collapse
Affiliation(s)
- P Sharma
- Department of Trauma and Orthopaedics, Keele University School of Medicine, Keele, UK
| | - KL Luscombe
- Department of Trauma and Orthopaedics, Keele University School of Medicine, Keele, UK
| | - N Maffulli
- Department of Trauma and Orthopaedics, Keele University School of Medicine, Keele, UK,
| |
Collapse
|
4
|
Calf injuries in professional football: Treat the patient or the scan? - A case study. Phys Ther Sport 2016; 21:63-7. [PMID: 27428536 DOI: 10.1016/j.ptsp.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 12/27/2015] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe a case of a professional football player with significant imaging findings despite a rather innocuous clinical presentation with gradual onset of calf pain and who was able to continue training and playing with minor medical intervention. To discuss some of the limitations of existing muscle injury grading systems and their potential to cover the full range of injury presentations for calf injuries. DESIGN Case report. SETTING A professional football player was assessed by physical examination, clinical testing and imaging (MRI) after a gradual onset of a calf injury. After returning to training and competition, a follow-up of his symptoms was performed with regular ultrasound imaging assessments. PARTICIPANT A professional football player (35 years, 1.90 m, 88 kg) male, African, striker, playing in the Professional Arabian Gulf League. CONCLUSION The discordance between the clinical presentation and the imaging findings resulted in a challenging situation regarding the decision of whether to allow the player to train and compete. In addition, existing muscle injury grading systems do not seem to cover the full range of injuries seen in clinical practice.
Collapse
|
5
|
Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS. J Bodyw Mov Ther 2015; 19:447-52. [DOI: 10.1016/j.jbmt.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/17/2014] [Accepted: 11/02/2014] [Indexed: 11/13/2022]
|
6
|
Analysis of knee flexion angles during 2 clinical versions of the heel raise test to assess soleus and gastrocnemius function. J Orthop Sports Phys Ther 2011; 41:505-13. [PMID: 21335928 DOI: 10.2519/jospt.2011.3489] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study, using a repeated-measures, counterbalanced design. OBJECTIVES To provide estimates on the average knee angle maintained, absolute knee angle error, and total repetitions performed during 2 versions of the heel raise test. BACKGROUND The heel raise test is performed in knee extension (EHRT) to assess gastrocnemius and knee flexion (FHRT) for soleus. However, it has not yet been determined whether select knee angles are maintained or whether total repetitions differ between the clinical versions of the heel raise test. METHODS Seventeen healthy males and females performed maximal heel raise repetitions in 0° (EHRT) and 30° (FHRT) of desired knee flexion. The average angle maintained and absolute error at the knee during the 2 versions, and total heel raise repetitions, were measured using motion analysis. Participants' kinematic measures were fitted into a generalized estimation equation model to provide estimates on EHRT and FHRT performance applicable to the general population. RESULTS The model estimates that average angles of 2.2° and 30.7° will be maintained at the knee by the general population during the EHRT and the FHRT, with an absolute angle error of 3.4° and 2.5°, respectively. In both versions, 40 repetitions should be completed. However, the average angles maintained by participants ranged from -6.3° to 21.6° during the EHRT and from 22.0° to 43.0° during the FHRT, with the highest absolute errors in knee position being 25.9° and 33.5°, respectively. CONCLUSION On average, select knee angles will be maintained by the general population during the select heel raise test versions, but individualized performance is variable and total repetitions do not distinguish between versions. Clinicians should, therefore, interpret select heel raise test outcomes with caution when used to respectively assess and rehabilitate soleus and gastrocnemius function.
Collapse
|
7
|
Tennis leg—a new variant of an old syndrome. Clin Rheumatol 2011; 30:855-7. [DOI: 10.1007/s10067-011-1681-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/04/2011] [Indexed: 11/27/2022]
|
8
|
Abstract
Acute injuries of the Achilles tendon are common among athletes and non-athletes alike. Injuries of other posterior calf muscles are far less common but should be considered in the differential, to ensure proper diagnosis and treatment of patients with calf injuries. This article focuses on these calf injuries, including injuries of the gastrocnemius, plantaris, soleus, and flexor hallucis longus, which may occasionally be mistaken for Achilles tendon disorders.
Collapse
|
9
|
Kwak HS, Han YM, Lee SY, Kim KN, Chung GH. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius ("tennis leg"). Korean J Radiol 2006; 7:193-8. [PMID: 16969049 PMCID: PMC2667601 DOI: 10.3348/kjr.2006.7.3.193] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Hyo-Sung Kwak
- Department of Radiology, Chonbuk National University Medical School, Chonju, Korea.
| | | | | | | | | |
Collapse
|
10
|
Abstract
Tennis is popular in the United States, with millions participating in the sport. Unlike many other sports, young, middle-aged, and elderly persons are actively playing tennis. Most injuries that are seen are secondary to overuse. Faulty stroke mechanics are often involved in the development of specific injuries seen in tennis players. Fortunately, most injuries respond to conservative treatment and do not require surgery. Most players are able to return to their previous level of activity after appropriate treatment.
Collapse
Affiliation(s)
- Robert H Perkins
- Department of Physical Medicine and Rehabilitation, The Ohio State University School of Medicine, Columbus, OH 43210, USA.
| | | |
Collapse
|
11
|
Kwak HS, Lee KB, Han YM. Ruptures of the medial head of the gastrocnemius ("tennis leg"): clinical outcome and compression effect. Clin Imaging 2006; 30:48-53. [PMID: 16377485 DOI: 10.1016/j.clinimag.2005.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Revised: 05/25/2005] [Indexed: 11/27/2022]
Abstract
UNLABELLED The purpose of this study is to describe the clinical outcome of conservative treatment in patients with rupture of the medial head of the gastrocnemius ("tennis leg") occurring during exercise and training and the effect of the compression treatment. MATERIALS AND METHODS Thirty patients (conservative treatment=15; compression treatment=15), aged 30-45 years, with clinically suspected rupture of the medial head of the gastrocnemius occurring during exercise and training were referred for ultrasonography (US) examination. All patients underwent US of the affected and contralateral asymptomatic limb. Follow-up clinical evaluation and US imaging of all patients each were performed at 1-week intervals during the month after injury and at 2-week intervals during the following 6 months. US findings were analyzed with respect to the integrity of the musculotendinous junctions of the gastrocnemius, the presence of a fluid collection, and the union time of the medial head of the gastrocnemius with the soleus muscle. In addition, we analyzed the clinical outcome of the compression treatment. RESULTS Of the 30 patients who had an initial US examination after their injury, partial rupture of the medial head of the gastrocnemius muscle was identified in 11 patients (36.7%); the remaining 19 patients were diagnosed with complete rupture. Fluid collection between the medial head of the gastrocnemius and the soleus muscle was identified in 25 patients (83.3%). First union of the medial head of the gastrocnemius with the soleus muscle in the compressive group was significantly rapid than that of the conservative group (4.25 vs. 3.25 weeks; P=.02). Fluid collection between the two muscles after 1 month in the compressive group was significantly smaller than that in the conservative group (8.9 vs. 4.5 mm; P=.01). CONCLUSIONS Early compressive treatment in patients with rupture of the medial head of the gastrocnemius decreases the hemorrhage amount and can be possible for early ambulation.
Collapse
Affiliation(s)
- Hyo-Sung Kwak
- Department of Diagnostic Radiology, Chonbuk National University Medical School, Chonbuk, South Korea.
| | | | | |
Collapse
|
12
|
Abstract
Lower extremity soft tissue injuries and overuse conditions are frequently encountered among athletes. Muscles are frequently strained or contused, arteries and nerves can become entrapped, and tendons and bursae can become inflamed. Familiarity with the anatomy of the involved area is essential for making the correct diagnosis. The majority of these conditions can be accurately diagnosed based on a thorough history and physical examination alone, without the need for expensive imaging or invasive tests. Most of these conditions can be successfully managed conservatively, avoiding surgical intervention.
Collapse
Affiliation(s)
- Michael D Pleacher
- Division of Sports Medicine, Department of Family Practice, Maine Medical Center, Portland, ME 04102, USA
| | | |
Collapse
|
13
|
Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study. Br J Sports Med 2005; 38:441-5. [PMID: 15273181 DOI: 10.1136/bjsm.2002.004499] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate in a military setting the potential role of intrinsic biomechanical and anthropometric risk factors for, and the incidence of, exertional medial tibial pain (EMTP). METHODS A prospective clinical outcome study in a cohort of 122 men and 36 women at the Australian Defence Force Academy. Each cadet underwent measurements of seven intrinsic variables: hip range of motion, leg length discrepancy, lean calf girth, maximum ankle dorsiflexion range, foot type, rear foot alignment, and tibial alignment. Test-retest reliability was undertaken on each variable. A physician recorded any cadet presenting with diagnostic criteria of EMTP. Records were analysed at 12 months for EMTP presentation and for military fitness test results. RESULTS 23 cadets (12 men, 11 women) met the criteria for EMTP after 12 months, with a cross gender (F/M) odds ratio of 3.1. In men, both internal and external range of hip motion was greater in those with EMTP: left internal (12 degrees, p = 0.000), right internal (8 degrees, p = 0.014), left external (8 degrees, p = 0.042), right external (9 degrees, p = 0.026). Lean calf girth was lower by 4.2% for the right leg (p = 0.040) but by only 2.9% for the left leg (p = 0.141). No intrinsic risk factor was associated with EMTP in women. EMTP was the major cause for non-completion of the run component of the ADFA fitness test in both men and women. CONCLUSIONS Greater internal and external hip range of motion and lower lean calf girth were associated with EMTP in male military cadets. Women had high rates of injury, although no intrinsic factor was identified. Reasons for this sex difference need to be identified.
Collapse
|
14
|
Abstract
A diverse set of conditions affect the lower extremities in athletes. Good history taking and knowledge of the anatomy of the affected areas can aid in accurate diagnosis. Most conditions can be treated conservatively with great success. Familiarity with rehabilitation strategies can assist physicians in working with physical therapists. New advances, especially in the therapy of plantar fasciitis, may aid physicians in more rapid treatment of conditions of overuse. Surgery can provide definitive relief from symptoms for athletes with whom conservative measures have failed.
Collapse
Affiliation(s)
- James L Glazer
- Division of Sports Medicine, Department of Family Practice, Chandler Medical Center, University of Kentucky, K 308 Kentucky Clinic, Lexington, KY 40536, USA
| | | |
Collapse
|
15
|
Lisle DK, Tucker JB. Exertional compartment syndrome in an equestrian does inadequate staffing compromise healthcare? PHYSICIAN SPORTSMED 2004; 32:33-6. [PMID: 20086400 DOI: 10.3810/psm.2004.02.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When evaluating lower-leg pain, the clinician must consider compartment syndrome resulting from exercise, even in the absence of trauma or if the exercise is seemingly benign. Equestrian sports would seem an unlikely source of acute compartment syndrome, but the examiner should consider unusual mechanisms of injury in any case. Although intracompartment tissue pressure measurements can help make the diagnosis, excessive pain is a more reliable early warning sign of acute compartment syndrome. A timely diagnosis and immediate surgical treatment may prevent serious long-term sequelae.
Collapse
|
16
|
Couture CJ, Karlson KA. Tibial stress injuries: decisive diagnosis and treatment of 'shin splints'. PHYSICIAN SPORTSMED 2002; 30:29-36. [PMID: 20086529 DOI: 10.3810/psm.2002.06.337] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tibial stress injuries, commonly called 'shin splints,' often result when bone remodeling processes adapt inadequately to repetitive stress. Physicians who care for athletic patients need a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are implications for appropriate diagnosis, management, and prevention.
Collapse
Affiliation(s)
- Christopher J Couture
- Family Medicine Residency, Ehrling Berquist Hospital, Offutt AFB, NB, 68113-2160, USA.
| | | |
Collapse
|
17
|
|
18
|
Abstract
This article presents an overview of sports-related injuries of the lower limb in children, with emphasis on the management. The special injury-related conditions of childhood, epidemiology, and the particular pattern of injuries are discussed. The increased participation of children in sports will continue. Permanent damage is a risk, and, as such, prevention should be the most important management in this age group. For example, stretching exercises should be performed with "warm" muscles. Excessive weight training has an unacceptable risk of injury. In endurance sports, the "10 percent rule," which consists of increasing activity by 10% each week, probably could be applied to prevent overuse injuries. A multifactorial approach may be helpful. The rationale for high performance, competitive sports for children is doubtful. The optimal levels of safe training will remain changeable and not predictable. It should be the responsibility of parents, coaches, and healthcare professionals to try and minimize the potential for injury and disability, and allow children to enjoy the benefits of sports.
Collapse
Affiliation(s)
- W Bruns
- Department of Orthopaedic Surgery, University of Aberdeen Medical School, Scotland
| | | |
Collapse
|
19
|
Ellen MI, Young JL, Sarni JL. Musculoskeletal rehabilitation and sports medicine. 3. Knee and lower extremity injuries. Arch Phys Med Rehabil 1999; 80:S59-67. [PMID: 10326904 DOI: 10.1016/s0003-9993(99)90104-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of knee and lower extremity injuries that commonly occur during athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.
Collapse
Affiliation(s)
- M I Ellen
- University of Pennsylvania Medical Center, Philadelphia 19104, USA
| | | | | |
Collapse
|