Test Your X-Ray IQ: Football Player with Leg Pain

A football player has lower leg pain after feeling a “popping sensation”. What happened?

Axial Lower Leg                                                                                                          Coronal Lower Leg

FHL= Flexor Hallucis Longus, TP= Tibialis Posterior, FDL=Flexor Digitorum Longus, S=Soleus, LHG=Lateral Head of Gastroc, MHG=Medial Head of Gastroc
Noted here is on this axial and coronal STIR (fluid sensitive) sequences is a well demarked area of high signal involving the soleus muscle.  There are regions of lower signal within the muscle (red star) which likely represents blood products in the muscle.  Striations of high signal are evident within the medial and lateral head of the gastroc. The FHL, TP, and FDL are normal.
This is most consistent with medial and lateral gastroc strain and tear of the soleus muscle. Clinical correlation would be helpful.
These are sometimes hard to tease out clinically, but MRI can give you a much clearer idea of what’s been strained and what’s been torn. These typically are not surgical cases, but sometimes doesn’t hurt to have someone take a look at it if you’re unsure. That’s why we build those relationships.

Plain film radiography can still be a helpful tool in evaluating for suspected soft tissue injuries (such as ACL tears) if you know what you’re looking for. Of course MRI is a much better modality, but x-ray can help guide you with your clinical evaluation.

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