骨科門診常見到的運動傷害
Tennis leg or acute Achilles tendon rupture?
"I was playing tennis last night and my leg gave way. It felt like someone kicked me in the back of my calf."
Figure – A tear of the musculotendinous junction of the medial head of the gastrocnemius muscle is known as tennis leg because this injury, common in recreational athletes, most often occurs in tennis players. The injury results from an acute forceful push-off with the foot and often occurs during a lunging shot when maximum tension is placed on the gastrocnemius as the lengthened muscle is contracted. Tearing also may occur in the soleus muscle. Tennis leg can be differentiated from an acute rupture of the Achilles tendon by noting the location of tenderness.
This common history is nearly pathognomonic of injury in the gastrocnemius-soleus muscle-tendon unit. A tear of the musculotendinous junction of the medial head of the gastrocnemius that results from an acute forceful push-off with the foot is known as tennis leg, because it occurs frequently in tennis players . One common mechanism of injury occurs during a lunging shot. The knee on the player's back leg is extended while the foot is dorsiflexed; maximum tension is placed on the gastrocnemius as the lengthened muscle is contracted at the push-off.
Tennis leg can be differentiated from an acute rupture of the Achilles tendon by noting the location of tenderness. In the former, tenderness is posteromedial at mid-calf; in the latter, tenderness is 1 to 6 cm proximal to the calcaneus over the Achilles tendon.
Also use the Thompson test. Ask the patient to lie prone on the examination table with his feet hanging off the end. A gentle squeeze of the calf elicits plantar flexion of the foot. If this squeeze does not elicit an amount of plantar flexion identical with that of the noninjured leg, the test result is considered abnormal and consistent with an acute rupture of the Achilles tendon.
