https://youtube.com/shorts/FB--s6N052w
Key Radiologic Points
Clinical Context
- Sudden calf pain during uphill running
- Sharp pulling sensation
- Classic presentation of acute calf strain
Where to Start on MRI
- Always begin with axial images
- In calf injuries, vertical tears are the diagnostic starting point, not a secondary finding
Key Anatomic Landmark
- Focus on the anterior aponeurosis of the medial gastrocnemius
- Normally seen as a thin, smooth, arcing low-signal line along the anterior muscle surface
Vertical Tear
- Focal interruption of the anterior aponeurosis
- Best found by inspecting areas adjacent to muscle edema or hematoma
- Once identified, it must be followed slice by slice
How to Find the Transverse Tear
- Track the same aponeurosis inferiorly
- Look for the sudden disappearance of the aponeurosis
- Muscle is present, but the aponeurosis is missing
- This combination defines a transverse tear gap
Most Common Pattern: L-Pattern Tear
- Primary partial-width transverse tear of the medial gastrocnemius aponeurosis
- Associated vertical tear at the lateral margin of the detached segment
- Inferior transverse component: usually full-thickness
- Vertical and superior components: typically partial-thickness
Important Pitfall
- Mild soleus edema may be present
- No injury to intramuscular tendons or aponeurotic junctions
- Recognize it, but do not let it distract from the primary pattern
Take-Home Message
- Vertical tears are the entry point to diagnosis
- Always follow them inferiorly to identify the transverse component
- Learn the L-pattern tear — it is the most common calf tear pattern
- Pattern recognition makes the diagnosis straightforward
#DrSlothic #SlothicRadiology #MSKMRI #CalfTear #CalfStrain #Gastrocnemius
#SportsMRI #MuscleInjury #PatternRecognition #RadiologyEducation
Visualizing MSK Radiology: A Practical Guide to Radiology Mastery
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