Ruptures of the medial gastrocnemius muscle (tennis leg)

Abstract

In 1883, Powell first reported in The Lancet on the "lawn tennis leg" (rupture of the medial head of the gastrocnemius). He described a 41-year-old healthy man who had sudden, sharp pain when reaching for the ball while playing tennis. Pain, tenderness, and swelling rapidly developed, but the patient was able to return to sports in 4 weeks. In 1958, Arner and Lindholm surgically explored five of 20 patients with tennis leg. In each case, a transverse rupture of the medial gastrocnemius at the musculotendinous junction was found. Ruptures of the medial head of the gastrocnemius muscle have been documented in patients ranging from adolescents to the elderly. The incidence is greatest in the middle-aged, as reported by Millar, who reported a mean age of 42 years for men and 46 for women, which suggests a degenerative process analogous to a rupture of the long head of the biceps, the rotator cuff of the shoulder, the Achilles tendon, or the attachment of the rectus femoris. Ruptures to the medial head of the gastrocnemius are nearly nonexistent in young tennis players with the same stresses. This injury seems to be most common in men. The term tennis leg arose because many patients suffering this injury were playing tennis at the time of injury. To understand why tennis leg is an injury of the middle-aged tennis player, one needs to consider the factors that may cause the gastrocnemius muscle to stretch and rupture. The flat-heeled tennis shoe allows excessive ankle dorsiflexion, which tightens the heel cord distally, while sudden knee extension increases the tension on the muscle belly proximally. Tennis is an active cutting sport that requires players to perform sudden movements that place the gastrocnemius in a position of risk. Of sports in which this age group generally participates, golf, swimming, walking, and jogging are not cutting sports. Other sports that do require cutting, such as football, basketball, and soccer, usually do not have much participation by individuals in their 40s and 50s in the United States. © Springer Science+Business Media, LLC 2009.