A retrospective evaluation of clinical records for patients referred for diagnostic ultrasound of posterior leg injuries

Abstract

BACKGROUND: ‘Tennis leg’, defined as injury to the distal musculotendinous junction of the medial gastrocnemius, is a relatively common injury sustained during sports and day to day activity. This condition is generally considered to most frequently affect people of middleage. Ultrasound imaging studies have demonstrated that the medial gastrocnemius is the injury most often observed in posterior leg injuries while magnetic resonance imaging studies generally show that soleus is more frequently injured. To date, current ultrasound studies do not report on all characteristics shown on ultrasound, unlike magnetic resonance imaging studies.

AIM: To describe the characteristics of clinical information for patients referred for ultrasound imaging of the posterior leg during a 12-month period within a musculoskeletal ultrasound clinic in Auckland, New Zealand.

METHODS: 3437 ultrasound reports from the 1st January 2018 to 31st December 2018 were retrospectively reviewed. 63 reports of calf muscle tear were included for final review, and all reported ultrasound imaging findings were extracted into a spreadsheet.

RESULTS: This study found 52 reports involving medial gastrocnemius, 9 reports of soleus tear, 1 report of lateral gastrocnemius and 1 report of plantaris tear. The distal musculotendinous junction of medial gastrocnemius was involved in 43 and 7 reported cases of medial gastrocnemius and soleus muscles respectively. In 12 reported cases, a tear was appreciated in the aponeurosis. A total of 22 haematomas were reported, 21 were appreciated alongside medial gastrocnemius tears, while one was in association with a soleus tear. Two reports were indicative of both a tear and associated deep vein thrombosis.

CONCLUSION: This study supports that the distal musculotendinous junction of the medial gastrocnemius is the site most frequently injured within the calf, and at least in this sample the middle-aged population were the most represented age group presenting for imaging. Ultrasound imaging appears to be useful in determining the site and extent of injury and also to determine the presence of associated pathology (particularly deep vein thrombosis) in order to determine the most appropriate management for the patient. Future research should determine the relationship between site and size of musculotendinous injury and the time taken to return to activity.