Chen Carl Pc, Tang Simon Ft, Hsu Chih-Chin, Chen Ruo Li, Hsu Rex Ch, Wu Chin-Wen, Chen Max Jl
J Med Case Rep. 2009 Jun 25;3:7291. doi: 10.4076/1752-1947-3-7291.
Rupture of the distal musculotendinous junction of the medial head of the gastrocnemius, also known as "tennis leg", can be readily examined using a soft tissue ultrasound. Loss of muscle fiber continuity and the occurrence of bloody fluid accumulation can be observed using ultrasound with the patient in the prone position; however, some cases may have normal ultrasound findings in this conventional position. We report a case of a middle-aged man with tennis leg. Ultrasound examination had normal findings during the first two attempts. During the third attempt, with the patient's calf muscles examined in an unconventional knee flexed position, sonographic findings resembling tennis leg were detected.
A 60-year-old man in good health visited our rehabilitation clinic complaining of left calf muscle pain. On suspicion of a ruptured left medial head gastrocnemius muscle, a soft tissue ultrasound examination was performed. An ultrasound examination revealed symmetrical findings of bilateral calf muscles without evidence of muscle rupture. A roentgenogram of the left lower limb did not reveal any bony lesions. An ultrasound examination one week later also revealed negative sonographic findings. However, he still complained of persistent pain in his left calf area. A different ultrasound examination approach was then performed with the patient lying in the supine position with his knee flexed at 90 degrees. The transducer was then placed pointing upwards to examine the muscles and well-defined anechoic fluid collections with areas of hypoechoic surroundings were observed.
For patients suffering from calf muscle area pain and suspicion of tennis leg, a soft tissue ultrasound is a simple tool to confirm the diagnosis. However, in the case of negative sonographic findings, we recommend trying a different positional approach to examine the calf muscles by ultrasound before the diagnosis of tennis leg can be ruled out.
腓肠肌内侧头远端肌腱肌肉连接处断裂，即所谓的“网球腿”，可通过软组织超声轻松检查。患者俯卧位时，超声可观察到肌纤维连续性中断及血性液体聚集情况；然而，部分病例在此常规体位下超声检查结果可能正常。我们报告一例中年男性网球腿病例。前两次超声检查结果均正常。第三次检查时，让患者处于非传统的屈膝位检查小腿肌肉，发现了类似网球腿的超声表现。
一名60岁健康男性因左小腿肌肉疼痛就诊于我们的康复诊所。怀疑左侧腓肠肌内侧头肌断裂，遂行软组织超声检查。超声检查显示双侧小腿肌肉对称，无肌肉断裂迹象。左下肢X线片未发现任何骨质病变。一周后的超声检查结果也为阴性。然而，他仍诉说左小腿区域持续疼痛。随后采用不同的超声检查方法，让患者仰卧位，膝关节屈曲90度。然后将超声探头向上放置以检查肌肉，观察到边界清晰的无回声液性暗区，其周围为低回声区。
对于小腿肌肉区域疼痛且怀疑网球腿的患者，软组织超声是确诊的简单工具。然而，若超声检查结果为阴性，在排除网球腿诊断之前，我们建议尝试采用不同的体位方法通过超声检查小腿肌肉。
