MANUAL MINORS
A calf muscle tear occurs when the muscle fibres of the gastrocnemius or soleus are torn due to excessive stretching or violent contraction. This injury is common in sports involving running, jumping, or sudden movements.
The tear can vary in severity, from a mild strain (Grade I) to a complete rupture of the muscle fibres (Grade III). Symptoms include sharp pain, swelling, bruising, and, in severe cases, an inability to walk.
Diagnosis
The diagnosis is based on clinical evaluation, with a history of sudden pain during physical activity, swelling, and potential inability to bear weight. Physical examination may reveal a localised area of pain, muscle spasms, and in severe cases, a palpable defect in the torn muscle.
Ultrasound is useful for assessing the extent of the tear, while magnetic resonance imaging (MRI) is used in more severe cases to plan treatment.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Achilles tendon rupture | Inability to flex the foot, positive Thompson’s sign, with an audible “snap” at the moment of rupture. |
Deep vein thrombosis (DVT) | Diffuse calf pain, swelling, warmth, and redness; confirmed by Doppler ultrasound. |
Muscle cramp | Sharp pain and temporary spasms, without persistent swelling or significant disability. |
Acute compartment syndrome | Disproportionate pain, significant swelling, possible loss of sensation or distal pulse. |
Muscle contusion | Pain from direct trauma, with no visible tear on ultrasound or MRI. |
Emergency Management
Initial management includes the RICE protocol (Rest, Ice, Compression, Elevation) to control inflammation and pain. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) should be administered.
In more severe tears, it is essential to immobilise the leg to prevent further muscle damage. The patient should be referred to a specialist to assess the need for physiotherapy or possible additional interventions, particularly if a high-grade tear is suspected.
Definitive Treatment
Treatment depends on the severity of the tear. Mild to moderate tears (Grade I and II) are typically managed with physiotherapy, progressive strengthening exercises, and relative rest for several weeks.
In Grade III tears (complete rupture), especially if the damage is extensive or affects function, surgical intervention may be necessary to repair the muscle. Afterwards, a rehabilitation programme is implemented to restore strength and flexibility, with a gradual return to physical activities.
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