Illustrated Encyclopedia of Human Anatomic Variation: Opus I: Muscular System: Alphabetical Listing of Muscles: G

Gastrocnemius and Soleus

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

The gastrocnemius is frequently joined by a separate fascicle or head known as the third head of gastrocnemius. It arises from some part of the popliteal surface of the femur. Caput tertium may also arise from the linea aspera, long head of biceps femoris, lateral epicondyle, knee joint capsule, midfibula, and the crural fascia. The third head may "split" and arise from more than one location or divide near its termination to join both heads of gastrocnemius. The third head may or may not cross popliteal neurovascular structures or some portions of the neurovascular component before insertion into one head, or the other, of gastrocnemius or its tendon. A third head joining the medial head of gastrocnemius is most commonly cited as causing clinical problems; the lateral head may also be involved.The conditions of intermittent claudication, arterial stasis and aneurysm, venous stasis, and impaired nerve function must have had a long undescribed clinical history before being discovered by Hamming. The third head is the most common variation of the gastrocnemius muscle and it has been studied extensively over a period of almost 200 years. Kelch (1813) is generally cited as the first to report the third head. The third head commonly joins the medial head of gastrocnemius and the third head, regardless of which head of gastrocnemius it joins, it has an overall frequency of 2.9 to 5.5%. Mori reported it present in 2.8% of his cases. The third head may be a potential problem for structures in the popliteal fossa as illustrated by Frey in 1919 and reproduced here. It is remarkable that the first clinical report was not published until 1959 (Hamming). There is no evidence from the literature that this is a familial variation but this needs further study.The plantaris muscle itself can be the third head. The plantaris may become the third head and may join gastrocnemius at the point where the medial and lateral heads separate, or may become continuous with the fascia beneath the muscle. It has also been seen passing between the popliteal artery and nerve.

Absence of the lateral head of gastrocnemius and its reduction to a fibrous cord has been reported.In some cases the two heads of gastrocnemius may be unjoined until their insertion onto the calcaneus and with separation from soleus. The absence of the tibial head of soleus has been reported. An accessory muscular slip (soleus accessorius) may arise from the soleal line with the soleus or be detached from the muscle distally. It lies between the soleus tendo achillis (externally or laterally) and flexor hallucis longus (internally or medially). It ends on the tendo achillis, or it may have a separate attachment on the medial surface of the calcaneus or tibial collateral ligament of the ankle.

Additional slips are

1. tensor fasciae plantaris, which inserts into the plantar fascia or quadratus plantae, and
2. peroneotibialis, which is a tensor of the tendinous arch of the soleus arising from the posterior aspect of the medial surface of the upper tibia and inserting into the tendinous arch (arcus tendineus) of soleus.

Peroneotibialis was found in 128 of 680 limbs; it usually occurs bilaterally, but, when unilateral, is more frequently found in the right limb. Either or both heads of gastrocnemius may be doubled, the lateral head may be absent.

Soleus may be doubled or absent.

Macalister reported the variations of gastrocnemius as follows;

1. Gastrocnemius may have a sesamoid bone in its medial head;
2. Or in its lateral head-this more common;
3. Or the two heads are separable further down than usual;
4. Or their tendon is perfectly separate from that of the soleus for a few inches (1 inch = 2.54 cm.);
5. The lateral head may have a few lower fibers attached to the external lateral ligament (ligamentum calcaneofibulare, ligamentum talofibulare anterius, and ligamentum talofibulare posterius);
6. Or to the posterior ligament of Winslow ( ligamentum collaterale fibulare);
7. A third head may be found from the middle of the popliteal triangle of the femur, and with a second slip from the posterior ligament of Winslow (ligamentum collaterale fibulare);
8. Or it may arise from the line leading from the medial condyle to the linea aspera, an inch (2.54 cm) above the medial head-this ended in a short tendon, which crossed the popliteal nerve, and inserted into the convergence of the two heads;
9. It may arise from a tendinous arch from the same ridge, higher up., which extends over the femoral vessels;
10. Or from the medial border of the long head of the biceps, forming a bicipiti accessorius (Haughton), similar to that of the lion, and many mammals (Kelch);
11. Or from the fascia of the leg (Meckel);
12. An intermediately arising third head, like 7. above, may be inserted with the lateral head;
13. Hyrtl describes an instance of this third head separate for a considerable extent;
14. The entire muscle may be bilaminar;
15. The lateral head may be entirely tendinous.

The variations of soleus according to Macalister follows.

1. Soleus: may have a bilaminar fibular head;
2. Soleus may have a a separate tibial portion inside the tendo Achillis inserted into the os calcis by a special tendon (Quain);
3. Soleus may be doubled (Cruveilhier);
4. A special tendon from soleus to the heel (Hellema)

Syn.: m. Gastroc. and soleus; triceps surae, surales, extensor pedis (Theile), Wadenmuskel, mm. gemelli.

Gastroc.: gastrocnemius externus, Jumeaux.
Soleus : gastrocnemius internus, Sohlenmuskel or correctly Schollenmuskel (Henle), Soléaire

.

Absence of the lateral head of Gastrocnemius
from Shepard, 1880

Gastrocnemius tertius
1a.: The CT scan on the left reveals an asymmetrical muscle mass (arrows) in the right popliteal fossa. The muscle mass joins the medial head of the right gastrocnemius muscle. 1b.: On the right side is a diagrammatic representation of the third head (*) of gastrocnemius that was redrawn form Chudzinski, 1882). The cut lines U, M, L correspond to the CT images shown on the left side. LH; Lateral head of gastrocnemius, MH; Medial head of gastrocnemius.

Twelve varieties of the third head of gastrocnemius
(redrawn from Frey, H., 1919)

1. Origin: Lateral to tibial nerve and popliteal vessels; Insertion: lateral head of gastrocnemius muscle.
2. Origin: Lateral to tibial nerve and popliteal vessels; Insertion: lateral head of gastrocnemius muscle.
3. Origin: Lateral to tiial nerve and popliteal vessels; Insertion: lateral head of gastrocnemius muscle.
4. Origin: Lateral to tibial nerve and popliteal vessels; Insertion: medial head of gastrocnemius muscle.
5. Origin: Lateral to the popliteal vessels; Insertion: medial head of gastrocnemius muscle.
6. Origin: Medial to the tibial nerve and popliteal vein, lateral to the popliteal artery; Insertion: medial head of gastrocnemius muscle.
7. Origin: Medial to the tibial nerve and popliteal vessels; Insertion: medial head of gastrocnemius muscle.
8. Origin: Medial to the tibial nerve and popliteal vein, lateral to the popliteal artery; Insertion: medial head of gastrocnemius muscle.
9. Origin: Medial to the tibial nerve and popliteal artery, lateral to popliteal vein; Insertion: medial head of gastrocnemius muscle.
10. Origin: Medial to the tibial nerve and popliteal vessels; Insertion: medial head of gastrocnemius muscle.
11. Origin: Medial to the tibial nerve and popliteal vessels; Insertion: lateral head of gastrocnemius muscle.
12. Origin: Popliteal fossa; Insertion: tendon of gastrocnemius muscle.

Medial; Medial head of gastrocnemius to the left side. Lateral; Lateral head of gastrocnemius to the right side.

Note: The neurovascular bundle in the popliteal fossa is, in part or entirely, potentially vulnerable in types 5, 6, 7, 8, 9, and 11 shown above.

Gastrocnemius tertius in a living subject

Accessory Soleus
Compare this muscle with Flexor Accessorius Longus.
source unknown.

References

Arnold,G. (1968) Seltene Gefass- und Muskelanomalien am bein. Anat. Anz. 123;471-475.

Bankart, J. Pye-Smith, P.H., and J.J. Phillips. (1869) Notes of abnormalities observed in the dissecting room during the winter sessions of 1866-7 and 1867-8. Guys Hospital Reports 14:436-455.

Bergman, R.A., Thompson, S.A., Afifi, A.K., and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation. Urban & Schwarzenberg, Baltimore and Munich.

Bergman, R.A., Walker, C.W. and G.Y. El-Khoury (1995) The third head of Gastrocnemius in CT images. Annals Anat. 177:291-294.

Biemans, R.G. M. and J.H. van Bockel. (1977) Popliteal artery entrapment syndrome. Surg.,Gynecol & Obstet. 144:604-609.

Bryce, T.H. (1897) Notes on the myology of a negro. J. Anat. Physiol. 31:612-618.

Chambardel-Dubreuil, L. (1925) Variations des arteres du pelvis et du membre inferieur. Masson & Cie, Paris.

Chudzinski, T. (1882) Contributions a l'etude des variations musculaires dans les races humaines. Revue D'Anthropologie. 5:280-308.

Connell, J. (1978) Popliteal vein entrapment. Brit. J. Surg. 65:351.

Delitzin, S.N. (1901) Über einen supernumerären Muskel des Unterschenkels (Musculus soleus accessorius?), welcher den Nervus tibialis durchbohrt. Internat. Monatschr. Anat. Physiol. 19:349-354.

Faller, A. (1942) Zur Deutung der akzessorischen Köpfe des Schollenmuskels. Anat. Anz. 93:161-179.

Flower, J.M. Note on an accessory soleus muscle. J. Anat. 65:548-549.

Forster, A. (1904) Das muskelsystem eines mannlichen Papua-Neugeborenen. Abhandlungen der Kaiserlichen Leopoldinish-Carolinischen Deutschen Akademie der Naturforscher 82:1-140.

Frey, H. (1913) Der musculus triceps surae in der primatenreihe. Gegenbaurs Morphol. Jahrbuch. 47:162-189.

Frey, H. (1919) Musculus gastrocnemius tertius. Gegenbaurs Morphol. Jahrbuch. 50:517-530.

Gruber, W. (1877) Über den musculus peroneo-tibialis beim Menschen. Arch. Anat. Physiol. Wissen. Med. 1877:401-410.

Gruber, W. (1878) Über den Sehnenbogen des Musculus soleus und seine ungewöhnlichen Spannmuskeln. Arch. Anat. Physiol. Wissen Med. 1878:474-480.

Haffner, H. von. (1908) Ein fall von doppelseitigem gastrocnemius tertius. Internat. Monatschr. Anay. Physiol. 25:263-272.

Halbertsma, H.J. (1862) Ontleedkundige Aanteekeningen. Verlagen en Mededeelingen der Koninklijke Akademie van Wetenschappen, Afdeeling Natuurkunde. 13:330-347.

Halliburton, W.D. (1881) Remarkable abnormality of the musculus biceps flexor cruris. Anat. Notices, J. Anat. Physiol. 15:296-299.

Hamming, J.J. (1959) Intermittent claudication at an early age, due to an anomalous course of the popliteal artery. Angiology 10:369-371.

Henle, J. (1871) Handbuch der Muskellhre des Menschen, in Handbuch der systematischen Anatomie des Menschen, Verlag von Friedrich Vieweg und Sohn, Braunschweig.

Hinterstoisser, H. (1888) Ueber einige seltene muskelvarietäten. Wiener Med. Jahrbücher 1888:407-422.

Huber, G.C. (1930) Piersol's Human Anatomy, 9th ed., Vol. 1., J.B. Lippincott Company, Philadelphia.

Insua, J.A., Young, J.R., and A.W. Humphries. (1970) Popliteal artery entrapment syndrome. Arch. Surg. 191:771-775.

Iwa, T., Sato, S., Yamada, T., Muraoka, Y., Sakurazawa, K., Kinoshita, H., Inoue, Y., Endo, M., Yoshida, T., and S. Suzuki. (1987) Popliteal vein entrapment caused by the third head of the gastrocnemius. muscle. Brit J. Surg. 74(11):1006-1008.

Kato, M. and S. Tofukuji. (1954) A case of the gastrocnemius tertius. Jikeikai Ikadaigaku Kaibogakukyoshitsu Gyosekishu. 11:1-5. In Japanese.

Kelch, W.G. (1813) Beiträge zur pathologischen Anatomie. 8, s.42, art. 36, Abweichung des Biceps Femoris. C. Salfeld, Berlin.

Laubach, K., Trede, M., and W.Saggau. (1973) Das Kompressionssyndrom der A. poplitea. Chirurg. 44:74-77.

LeDouble, A.F. (1897) Traité des Variations du Système Musculaire de l'Homme et Leur Signification au Point de Vue de l'Anthropologie Zoologique., Librairie C. Reinwald, éds., Schleicher Frères, Paris.

Loetzke, H.H. und K. Trzenschik. (1969) Beitrag zur frage der Varianten des M. soleus beim Menschen. Anat. Anz. 124:28-36

Macalister, A. (1875) Observations on muscular anomaiies in human anatomy. Third series with a catalogue of the principal muscular variations hitherto published. Trans. Roy.Irish Acad. Sci. 25:1-130.

Mentha, C. (1966) Malposition et sténose extrinsèque de l'artere popliteal par la compression musculo-tenineuse du jumeau interne. J. Chir. 91:489-500.

Miaskiewicz, C. (1970) Studies on the morphology of the gastrocnemius muscle in the black race. Folia Morphol. (Warsaw). 29:266-272.

Nakashima, H. and M. Nakanishi. (1898) On the anomaly of the gastrocnemius. Juzenkai Zasshi. 5:37-39. In Japanese.

Nishimoto, K. (1938) One case of the M. gastrocnemius tertius. Nagasaki Igakkai Zasshi. 16:2470-2475. In Japanese.

Pye-Smith, P.H., Howse, H.G., and J.N.C. Davies-Colley. (1871) Notes of abnormalities observed in the dissecting room during the winter sessions of 1868-69 and 1869-70. Guy's Hospital Reports. 16:147-165.

Rich, N.M. (1967) Popliteal artery and vein entrapment. Am. J. Surg. 113(May):696-698.

Rich, N.M., Collins,Jr.,G.J., McDonald, P.T., Kozloff, L., Clagett, P. and J.T. Collins. (1979) Popliteal vascular entrapment. Arch. Surg. 114:1377-1384.

Ruge, G. (1884) Beiträge zur Gefässlehre des Menschen. Gegenbaurs Morpolog. Jahrbuch. 9:229-388.

Schafer, E.A. and G.D. Thane. (1894) Quain's Elements of Anatomy. 10th ed. Vol.2., Pt.2., Arthrology, Myology, Angeiology. Longmans Green and Co., London.

Seki, S. (1952) Ueber die relative Länge der Gastrocnemiussehne im Vergleich zu der Länge der tibia und über die Korrelation des Muskelsehnenindexes des Gastrocnemius und der Tibialänge bei Japanern. Folia anatomica japonica. 24:307-312.

Seki, S. (1953) Relative length of the triceps cruralis to the length of the tibia. Kaibogaku Zasshi. 28:Supple. Chugoku-Shikoku 8-9. In Japanese.

Shepherd, F.J. (1880) Notes of abnormalities observed in the dissecting-room of McGill University, from October, 1875, to May, 1879. Canada Med. Surg. Journal. 1:71-93.

Suzuki, T. (1938) The pattern of the terminal tendon of the M. semembranosus and the reticulum around the knee-joint. Tokyo Igakkai Zasshi. 52:801-809. In Japanese.

Ternowsky, W.N. and M. Sadikowa. (1926) Ein akzessorischer M. soleus. Anat. Anz. 61:280-284.

Testut, L. (1884) Les Anomalies Musculaires Chez l'Homme Expliquees par l'Anatomie Comparee Leur Importance en Anthropologie. G. Masson, Ed., Libraire de l'Academe de Medecine, Paris.

Tochihara, J. und T. Onozawa. (1932-33). über den M. gastrocnemius tertius bei den Japanern. Kaibocirc Zasshi (Tokyo). 5:589-600. In Japanese.

Turner, W. (1897) Notes on the dissection of a third negro. J. Anat. Physiol. 31:624-626.

Walsham, W.J. (1880) Anatomical variations: An account of a few of the more interesting abnormalities that have occurred in the dissecting rooms during the last seven years; with remarks on their morphological significance, and their bearing on the practice of surgery. St. Bartholomews Hospital Reports. 16:69-105.

Williams, P.L., Warwick, R., Dyson, M. and L.H. Bannister, Eds. (1989) Gray's Anatomy, 37th ed., Churchill Livingston, Edinburgh.

Yano, K. (1927) Das Os sesamoideum musculi gastrocnemii lateralis bei der Japanern. Folia Anatomica Japonica. 6:241-246.

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