Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Rupture of the Gastrocnemius or Soleus Muscles

SYMPTOMS

There is an acute onset of sharp tearing pain in the calf during activity. This injury often occurs in middle-aged recreational athletes in sports such as tennis or squash or other sprinting and jumping sports.

AETIOLOGY

This is usually a partial (Grade I-II) rupture of the medial or lateral bulk of the gastrocnemius or soleus muscles. The rupture usually occurs at the musculo-tendinous junction. A complete (Grade III-IV) rupture on this location is rare.

CLINICAL FINDINGS

There is tenderness on palpation over a localised area of the muscle bulk. Resistance tests of the muscle in question will cause further pain. Jumping and landing on the forefoot with a straight knee is most painful for a gastrocnemius rupture while landing with a flexed knee causes more pain if the deeper soleus muscle is ruptured.

INVESTIGATIONS

This diagnosis is made from patient history and clinical findings. Ultrasound or MRI can demonstrate the rupture and haematoma. These investigations are important when the initial diagnosis has been missed, to rule out an intramuscular haematoma that may require surgical evacuation and to grade the rupture, which is important for rehabilitation and length of absence from sport.

TREATMENT

This injury most often responds to conservative treatment including modification of training and strength exercises over three months, the usual healing time. Partial weight bearing is usually allowed.

REFERRALS

Refer to orthopaedic surgeon for consideration of surgery if symptoms are severe or diagnosis is delayed. Refer to physiotherapist for planning of a three to six months’ return programme back to sport.

EXERCISE PRESCRIPTION

Cycling and swimming and other low-impact activities are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Strength and flexibility must be monitored objectively to be the same as the other leg at the end of rehabilitation or there is a high risk that the weaker muscle will re-rupture.

DIFFERENTIAL DIAGNOSES

Achilles tendon rupture (different location); DVT (gradual onset but can be difficult to rule out if the patient has recently taken a long-haul flight or had surgery).

PROGNOSIS

Excellent but re- ruptures are common following a too-early return to sport and insufficient rehabilitation.

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