Bartholomew Way Clinic Physiotherapists
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  • Calf Muscle Tear – Ultrasound imaging case study

    Posted on February 17th, 2011 admin No comments

    Ultrasound scanning will immediately show us whether you have a tear or a simple strain. Tears show up very clearly, as do collections of blood in the muscle.

    At first assessment 5 weeks post injury

    The scan above (fig 1) shows a large tear of the Gastrocnemius muscle. Amazingly, this was some 5 weeks AFTER the trauma. The left hand frame shows a dark area (called a hypo echoic signal) between two parts of the muscle that should be attached; it is 12mm deep; in the right hand frame the gap is closed down to 6.5mm by firm pressure via the scanner head. It was clear that the gap was filled with blood / fluid. Under live scanning, we could see the fluid & debris moving within the defect
    We were able to surface mark the entire extent of the haematoma in this gentleman’s calf muscle using ultrasound scanning.
    The patient was treated with regular sessions of local ultrasound therapy, gentle remedial exercises and massage, with firm compression support 24 hours a day.

    2 weeks after treatment has begun

    The second scan (fig 2) was taken 2 weeks later, and shows the gap closing satisfactorily with treatment.

    4 weeks after beginning treatment

    The third scan (fig 3) was taken 2weeks later, and continues to show good progress.

    Healing continues....

    The fourth scan shows no hypo echoic signal, and you can clearly see the two parts of the muscle are now joined together by scar tissues. The scar is thicker (3.42mm) than the normal tissues that would be there (intermuscular septum) but they are, at least, now attached. He was able to increase his weight bearing exercsie steadily throughout the healing period, safe in the knowledge that the tissues were healing.

    Final scan

    A further scan was taken two months later, following increasingly dynamic muscle work and re-education. It shows that the scar has been stretched open a little, and now measures 5.11mm. however, it is functionally strong, and he has returned to Martial Arts sports.

    David is not a qualified sonographer. However like many physiotherapists in musculo-skeletal practice, he has received basic training in the use of ultrasound imaging equipment and uses it to confirm his assessment findings and measure progress in recovery from certain injuries.

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