Answer for CoW 12 Feb 2017
Findings
Diagnosis: Tennis leg ( Plantaris tendon rupture ). T2-weighted axial image demonstrates fluid between the soleus muscle and the medial head of the gastrocnemius muscle . Irregular low signal intensity within the fluid collection represents the remnant of the ruptured plantaris tendon.Signal within the gastrocnemius is normal. T2-weighted coronal image reveals how the fluid collection follows the characteristic oblique course of the plantaris tendon, with low signal intensity tendon fragments visible within fluid .
Discussion
The plantaris is an accessory muscle, absent in 7%-20% of the population . It assists with plantar flexion of the calf muscle and is commonly harvested by surgeons for tendon grafts . The plantaris composes part of the posterosuperficial compartment of the calf. In association with the gastrocnemius and soleus muscles, it forms the triceps surae unit . The plantaris muscle belly is approximately 7-13 cm in length . It originates from the lateral supracondylar line of the femur and inserts onto the calcaneus . The muscle belly originates superior to both the medial and lateral heads of the gastrocnemius and lies deep to the lateral head of the gastrocnemius . The plantaris myotendinous junction occurs at the level of origin of the soleus muscle . The plantaris tendon courses toward the medial aspect of the lower extremity, running between the medial head of the gastrocnemius and the soleus muscle. It courses near the medial border of the Achilles tendon and inserts onto the calcaneus, anteromedially to the Achilles tendon . Because it spans 2 joints, the knee and the ankle, the plantaris may have an increased likelihood of injury . “Tennis leg” was first described by Powell in 1883 . The classic presentation is acute mid-calf pain in a middle-aged person. This is most often a sports-associated injury, incurred during extension of the knee and forced dorsiflexion of the ankle. Often, a “snapping” sensation is both felt and heard by the patient. Pathophysiology of tennis leg was attributed to rupture of the plantaris tendon.
Diagnosis: Tennis leg ( Plantaris tendon rupture ). T2-weighted axial image demonstrates fluid between the soleus muscle and the medial head of the gastrocnemius muscle . Irregular low signal intensity within the fluid collection represents the remnant of the ruptured plantaris tendon.Signal within the gastrocnemius is normal. T2-weighted coronal image reveals how the fluid collection follows the characteristic oblique course of the plantaris tendon, with low signal intensity tendon fragments visible within fluid .
Discussion
The plantaris is an accessory muscle, absent in 7%-20% of the population . It assists with plantar flexion of the calf muscle and is commonly harvested by surgeons for tendon grafts . The plantaris composes part of the posterosuperficial compartment of the calf. In association with the gastrocnemius and soleus muscles, it forms the triceps surae unit . The plantaris muscle belly is approximately 7-13 cm in length . It originates from the lateral supracondylar line of the femur and inserts onto the calcaneus . The muscle belly originates superior to both the medial and lateral heads of the gastrocnemius and lies deep to the lateral head of the gastrocnemius . The plantaris myotendinous junction occurs at the level of origin of the soleus muscle . The plantaris tendon courses toward the medial aspect of the lower extremity, running between the medial head of the gastrocnemius and the soleus muscle. It courses near the medial border of the Achilles tendon and inserts onto the calcaneus, anteromedially to the Achilles tendon . Because it spans 2 joints, the knee and the ankle, the plantaris may have an increased likelihood of injury . “Tennis leg” was first described by Powell in 1883 . The classic presentation is acute mid-calf pain in a middle-aged person. This is most often a sports-associated injury, incurred during extension of the knee and forced dorsiflexion of the ankle. Often, a “snapping” sensation is both felt and heard by the patient. Pathophysiology of tennis leg was attributed to rupture of the plantaris tendon.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!