Soleus Myotendinous Junction Injury

About aponeurotic medial insertion injury of the soleus muscle.

Knowing the anatomy and biomechanics of the gastrocnemius-soleus complex – or triceps surae – is crucial for an understanding of the etiology and treatment of all its possible injuries. Today I want to show you a painful partial lesion at the aponeurotic medial insertion of the soleus muscle in a professional soccer player.

One month after a soleus injury, a patient suffered for pain and discomfort at the distal soleus myotendinous junction; first examination was made with an ultraportable device directly on the pitch during a daily training session. A partial injury of the aponeurotic medial insertion was evident, togheter with muscle perilesional edema.

soleus-injury

Sagittal Ultrasound comparative examination of the medial soleus myotendinous junction; normal findings on the right side.

soleus-medial-insertion

Sagittal GeStir (left) and Coronal T2w Mri scans of the same patient (0.3 Tesla).

fse_t2__2__and_fse_t2__4_

Axial (left) and Sagittal (right) T2w Mri scans (0.3 Tesla).

With the dynamic ultrasound examination is better appreciated also an inflammation along the course of the posterior tibial nerve.

Also in this case the elastosonography evaluation works like a “contrast agent” well depicting the lesional area.

You can find further information about the complex anatomy of the triceps surae in this interesting scientific paper: Anatomy of the Triceps Surae: A Pictorial Essay

 

Calf Muscle Contusion

Professional football player; contusion of soleus muscle at its proximal third, produced by a direct trauma during a match;  interstitial edema and hemorrhage is evident.

soleus-contusion

Multiplanar T2w Mri imaging (0.3 Tesla) of a soleus high degree contusive injury.

Despite of their appearence, contusions tend to have a recovery time significantly shorter then undirect traumas. In this case the athlete never missed a match.

A recognized complication of muscular contusion is myositis ossificans, so it’s very important the ultrasound monitoring.

Intramuscular haematoma and oedema at the postero-medial aspects of the soleus muscle are depicted, with post-traumatic hypervascularity.

Always perform both Mri and dynamic ultrasound imaging for a better definition  of this kind of injury.