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Full text of 'Pachislo Slot Machine Ver. 1.0PACHISLO SLOT MACHINEOperations / Maintenance / Modifications / Troubleshootingi-.■.' ■ ' inovembre 26, 2006Version (1.0)Pachislo Slot Machine Ver. 1.0 2InstructionsOBJECT OF THE GAME: The object of the game is to line up winning symbolsby stopping the spinning reels one-at-a-time.1.0 Game Set-up and Preparation:1.1 Open the Main DoorUnlock and open the front door with the key provided by your retailer (this keywill be found somewhere in the packing materials - in the bags with the slottokens or connected to the spin handle on the front of the slot machine). Inspectthe exterior for any obvious damage to the machine. Make a note of any damageto the exterior before proceeding. Inspect the interior for any loose wiring, excesspacking materials, and obvious damage caused during shipping.
If you find anydamage, save all packing materials and contact the company you purchased themachine from. They will instruct you on their procedure for repairs, replacementsand returns.1.2 Plugging in Your Slot Machine to ACPlug the external AC power cord into a 120 Volt AC outlet (standard U.S.A.outlet). It is preferable to plug your unit into a UL approved surge protector (e.g.such as the ones you use with your computer). This will protect your SlotMachine from power surges and allow you to turn the machine on and off withoutopening the door each time.
Remember - your slot machine has circuit boards andPachislo Slot Machine Ver. 1.0 3is a computer on its own accord. When the slot machine is not in use or beingattended - unplug the machine or turn the surge protector off.Some machines are equipped with a power transformer that stays on all the timewhen the machine is plugged in.
If your machine is equipped with one, it isusually located inside the cabinet near the coin hopper. It is a gold rectangular boxwith wires attached to terminals on both sides. DO NOT TOUCH the terminalswhen the machine is plugged in. This is live electric and touching the terminals isjust like putting your finger in a socket/outlet.Do not seal openings/vents in the machine cabinet since this allows air tocirculate around the electronic components. However, there might be a largeopening - about the size of your hand in the centre of the back of the machine.This hole was created for your retailer to unlock the door initially before they hadaccess to the exact key for your unit.
You can close this opening if your like.Sometimes it is unsightly and you might like to fix this as a cosmetic feature.Unlike a computer, your pachislo slot machine does not have a built-in coolingfan. Sealing cabinet holes will cause your machine to overheat and is a firehazard.Caution: Keep this machine and all electric/electronic equipment away fromwater. Never work on the inside of the machine with the power on. Remember -safety first!1.3 Removing & Loading the Payout HopperLocate the payout hopper and remove it from the machine. If the hopper isconnected to a wire harness be sure to disconnect it first.
Also, some machineshave a mechanism located at the base of the hopper to help hold it in place.Press down to release hopper, then slide hopper out of track.Pachislo Slot Machine Ver. 1.0Loading the Hopper Insert at least 400 tokens into the top of the hopper, as thiswill load the hopper for payoffs1.4 Turning the Machine OnTurn the machine power switch (located halfway up inside of machine on leftside) to the ON position. The machine will go through a series of test procedures.When the INSERT MEDAL light flashes, the machine is ready for play.1.5 Setting the Credit/Collect ModeIf the CREDIT display is lit (0), the machine is in the CREDIT mode.
Allsubsequent winning will be added to the credit meter. If the CREDIT display isnot lit, the machine is in the automatic payout mode. All subsequent winnings willbe automatically dispensed in tokens by the hopper. To change between modes,press the CREDIT-COLLECT button while the machine is idle. You cannotchange modes while the machine is in play or when tokens have already beeninserted.Pachislo Slot Machine Ver. 1.0Not all machines will give you the option to change between credit and collect.On some of the newer machines - you are always in the credit mode up to 50tokens - unless you press the collect button. If you notice above - the creditbutton can be on either the left or right side of the machine - depending on thebrand and model.2.0 Playing the Machine2.1 Insert TokensInsert from 1-3 tokens.
(1) token will illuminate the centre pay line, (2) tokenswill illuminate the upper and lower pay lines, (3) tokens illuminate the diagonalpay lines. With all 3 tokens inserted, the maximum number of combinations areselected. These machines have a speed loaders which allows you to insert a stackof 20 tokens at one time. Just jiggle the stack of tokens to speed load!Pachislo Slol Machine Ver. 1.02.2 Credit MeterAt this time, if the machine is in the CREDIT mode, you may insert up to 50additional tokens for further play.
The excess amount of tokens will be displayedin the CREDIT METER. Machine will not display more than 50 credits. Anytokens inserted when the CREDIT METER displays 50 will be rejected and willdrop into the coin tray. When you have extra credits in the machine -just pressthe Max Bet button - and then spin the reels.2.3 Play HandlePress or lift on Play Handle - it may be black - or it may be light in a colour onother models.Pachislo Slot Machine Ver. 1.02.4 Skill/Stop ButtonsAs the reels spin, push the STOP burtons one at a time, in any order to stop thereels.
The stop buttons may be lighted - or not - and may change colours!2.5 Winning CombinationIf a winning combination is 'HIT', the corresponding win will automatically bepaid out by the hopper or credited to the machines CREDIT display meter. Ifthere are no credits on the CREDIT METER, insert 1-3 tokens to repeat gameplay.Pachislo Slot Machine Ver. 1.082.6 Play Credit ButtonIf the machine is being used in the credit mode, the PLAY CREDIT button maybe utilized to credit a pay line, one at a time, assuming there are credits displayedon the CREDIT meter.Pachislo SIol Machine Ver. 1.03.0 Game OperationThe machine has the capability of 'HOLDING' (storing) 1-50 credits on theCREDIT display meter. Any win condition that exceeds the CREDIT meter limitof 50 will automatically be dispensed by the hopper in tokens. The SKILL-STOPbuttons are operational ONLY when the 'STOP' lights are lit over the buttons.Only one button may be pushed at a time.
In case of a 'JACKPOT' (777 on anyilluminated pay line) up to 50 credits will be added to the CREDIT display meterwith the remaining coins being dispensed by the hopper. When the machinesenses an abnormal condition, the machine will 'LOCK UP' (tilt) and a siren willsound.
Refer to the TROUBLESHOOTING GUIDE for explanation of problemsand correction procedures3.1 Bonus GameOccasionally during play a BIG CHANCE (777) combination or BONUS GAMEcombination is HIT, thereby guaranteeing the player a predetermined number of'WINS'. The machine will initially pay out the amount listed for the combination(usually 15 tokens), then the machine will give you additional guaranteed winsduring the next several plays. Depending on the bonus combination, severalwinning plays will occur, paying a maximum of approximately 500 coins whenbonus play is complete.
Bonus Games take place on the CENTER pay line only.BONUS GAME Combinations = 15 tokens + 8 guaranteed winsBIG CHANCE Combinations = 15 tokens + 24 guaranteed wins in 3 rounds. Thebig chance round is set up with 3 sets of 8 guaranteed wins, between round 1 and2 and also 2 and 3 you will notice the music changes and this is a bonus periodwith increased odds. This period continues until you hit a free game. It is possibleto win up to 35 payouts (500 tokens) in the 'Big Chance' play mode.CHALLENGE GAME (on some machines including Ward of Lights) allows youto play (1 to 3 tokens) up to 200 consecutive times with increased winning odds.If you enter the Challenge Game after the Big Chance round you will have aminimum of 150 spins with increased winning payouts. If you enter theCHALLENGE GAME you must finish ALL spins. The machine cannot be resetwhile in this mode!
It can be turned off but when you turn it back on it will still bein the Challenge Game mode.Pachislo Slot Machine Ver. 1.010After a 777 bonus game is complete, the GAME OVER light may flash.
Themachine must be reset. To reset the machine, insert barrel key into the frontdoor and turn to the left.
ONCE A MACHINE HAS ENTERED THE BONUSGAME IT IS NECESSARY TO PLAY THE MACHINE UNTIL THE BONUSGAME IS COMPLETE3.2 Changing Game OddsPachislo Slot Machine Ver. 1.0MGame odds are adjustable to 6 different levels. Viewing of the game odds can beinside the door or on the outside of the door, depending on the make and model ofthe machine. The one above shows the odds are set to the easiest - level 6. Oddslevels do vary by machine.
Here are the average winning odds per level:LEVEL 1=65-67%LEVEL 2=72-74%LEVEL 3=79-81%LEVEL 4=88-95%LEVEL 5=105-107%LEVEL 6=115-125%To Change Odds3.3.1 Get Machine into Idle ModeIn order to change odds, machine must be in idle mode with no tokens or creditsbeing played. Locate internal toggle switch (red tipped or silver with on/off tabs)or insert key into internal key switch (if your machine came with 2 keys).Machine must be turned OFF.
Turn key clockwise or flip reset toggle switch toPachislo Slot Machine Ver. 1.0 12the 'ON' or 'ODDS' position.
Turn main power switch ON to accessprogramming mode.On the SAMMY models, the reset button (Blue) is located on the inside of themain door.On the OLYMPIA/HEIWA models the white button on the power supply box isthe reset.3.3,2 Setting the OddsA number from 1 to 6 will be displayed on the CREDIT meter on the front dooror on a display inside the door. Locate the reset button. This will be located onyour power supply. On SAMMY brand models, the button is on the inside of thedoor only.Depress the button and notice movement of number being displayed on thecredit meter. Once the desired level is displayed (1 to 6) pull 'spin reels' handle(black or red knob on front door) down, like you are going to spin the reels, tolock odds level into machine memory.
Turn key switch back or flip toggle to'OFF' or 'PLAY' position. Machine should immediately initialize. You willknow the machine initialized if the 'Insert Medal' light starts flashing. If not,make sure you remembered to press down the 'SPIN REELS' lever.If it still doesn't initialize, turn power to the OFF position, wait 15 seconds andturn power switch back to ON position.Machines with 4 or 6 reels On a pachislo slot machine the additional reels let youknow when you are about to win they do not increase the payout. Some do it withLCD's / a fourth reel - or with WIN lights such as on the Babel machine.Pachislo Slot Machine Ver. 1.0 13ALL 4th REEL MACHINES - The 4th reel only spins to indicate you are going towin or to tease you into thinking you are going to win. The symbol the 4th reelstops on indicates the winning combination you are going to win on this turn.Some symbols are guaranteed wins and others do not pay any tokens/coins at all.FEVER QUEEN (6 Reels) - The top 3 reels only spin if you are going to have awinning combination.
The 3 top reels let you know which combination you aregoing to win on the lower three wheels. If you get a king, jack and 7 on the topreels that indicates on this turn you are going to win with one of thosecombinations on the lower 3 reels.
As you play you will notice 7's begin todisplay on the top 3 reels. When you have 3-7's on the top reels you are going tohit the big bonus very soon.LAS VEGAS - The roulette reels main purpose is to keep the player in the seatand it does spin randomly.TOM CAT - This reel spins to get you ready for the bonus round and add to theexcitement - however - don't expect to win every time it spins!BABEL - The 4th reel on this model will spin to 7 when you are going intowinning mode. You can hit 3 7's without it being on 7 - but when it hits 7 on thetop reel - you will win soon!CLUB RODEO - A real fun machine - has a LCD next to the reels. It talks andmakes exciting graphics - however if it shows a 3 - you will have a small win andif it shows a 7 - you will have a big win!At the end of the Big Bonus the wheel will spin again. If it stops on the 3 - 100chips the bonus period is over. If it lands on one of the games listed on the wheel(ex.
Fruit game) then the bonus period is extended. During the Big Bonus when Idid not win an extended game on the wheel, all of my tokens were dispensed fromthe machine and the siren went off but no error code was displayed. Sometimes atthe end of a Big Bonus the machines are set up to notify the casino it just paid off.The machine needs to be reset and this can be done by turning the main door keycounter-clockwise (to the left). If this does not clear the siren it may be necessaryto open the door and do a full reset.3.3.3 Safety InformationWARNING: To reduce the risk of burns, fire, electric shock or injury to personsA machine should never be left unattended when plugged in.Unplug from outlet when not in use, and before putting on or taking off parts.Pachislo Slot Machine Ver. 1.014Close supervision is necessary when this machine is used by children, invalids ordisabled persons.Do not operate the machine with the air openings blocked. Do not seal or coveropening on back and sides of machine.
Excessive heating can occur and causefire, electric shock or injury to persons.Never operate this machine if it has a damaged cord or plug, if it is not workingproperly, if it has been dropped or damaged or if it has been dropped into water.Always keep the power cord away from heated surfaces.Never drop or insert anything into any opening. Always unplug machine beforeattempting any service.Do not use outdoors.Do not use machine when standing on a damp floor, or when any part of thebody is in contact with plumbing or any similar ground.To disconnect, turn all controls to the OFF position, then remove plug fromoutlet.This unit is designed to operate on standard 120 Volt 60 Hz house current.4.0 TroubleshootingThe following section describes troubleshooting tips to help you determine aproblem, if any. If you encounter a problem please contact the company youpurchased the machine from.4.1 Machine does not power upMake sure machine is plugged into a 1 20 VAC outlet. Do not use an extensioncord longer than 100 feet.
It is best to use a UL approved surge protector as yourextension cord - and you can also use it to power the machine on and off insteadof having to open the front door each time.Pachislo Slot Machine Ver. 1.0 154.2 No Lights(fuse picture to be added)Make sure power switch is in the ON position. We check allmachines before they leave our shop so this should not be a problem unless afuse blows. Extra fuses are included in the Casino Kit.4.3 Machine does not accept TokensMachine must be turned ON. Jackpot condition may have occurred if 'GAMEOVER' light is flashing. Reset machine by inserting barrel key in lower lock onfront door and turn it to the left4.4 Machine keeps playing in bonus GameThis may be normal, keep playing until the bonus game is complete.
You mayhave to play as many as 250 spins to complete the Bonus Game (Big ChanceLevel).4.5 Hopper will not pay out - Trouble CodesCheck payout hopper, make sure wire harness is plugged in and secure.Check fuses.Make sure hopper is aligned with payout slot on front door.With use, the hopper collects dirt from the coins and needs to be lubricated.Unplug wire harness and remove hopper from machine. Remove all coins fromthe hopper. Spin hopper base (looks like a old telephone dial) in a clockwisedirection to remove additional tokens/quarters then lightly spray area with WD-40.
Spin hopper base with your hand until lubricant is evenly distributed andhopper spins freely. Put hopper back in machine and plug in wire harness.4.6 Trouble Code Displayed on Front Door of Machine:HE - Hopper Empty - Not enough tokens for payout. Add tokens to hopper.HO - Hopper Out - Hopper is out of tokens. Add tokens to hopper.HJ - Hopper Jam - Remove coin hopper.
Unplug wiring harness and slidePachislo Slot Machine Ver. 1.0 16hopper out. Dump out coins, some coins will remain in the lower hopper area.
Toclear them, spin centre of hopper until all coins are free and hopper spins freely.Reset machine by depressing RESET switchSee more error code at the end of the book4.7 Machine Volume too loud / too softAdjust volume control switch located on:(1) Right side of speaker on inside of door near coin tray.(2) Or on the amplifier - follow the wires from the speaker to the circuit board -on that circuit board - you will see a small switch that will move to the left orright- move the switch to the next position - test the sound.Make sure wire harness to speaker is connected.' OF Trouble Code'Machine needs to be restarted after bonus mode.Reset machine, in some cases you must reset the odds in order to clear thiscodeReels hesitate or Don't Spin / Reels won't stop spinning with stop buttonsMake sure all 3 wire harnesses to reel bundles are plugged in and secure.Manually spin reels to make sure they spin freely. The reels should spin freelywith no obstruction. Reset machine by depressing the RESET switch.Reels won't stop spinning when the stop button is pushed:Stop buttons must be cleaned.
Put Windex on a paper towel or use a baby wipe toclean the area where the buttons touch the bezel. Dirt tends to build up in thecrevice so depress the button to clean this area.
You can also use your fingernailwith a baby wipe over it to clean around the buttons4.7.1 Volume Control Modification InstructionsAfter switching the volume buttons - the volume is still too loud, you can add aresistive transistor (volume control knob) to each speaker. Installation of theseparts is done at the owner's risk. However - I have done this to all of mymachines - and it works well! The neighbours in the next apartment don'tcomplain anymore.Here is a parts list and diagram for installation of an in-line volume control.Pachislo Slot Machine Ver. 1.017Parts Required:. Radio Shack Part Number 271-215 'Mini Volume Control' ($2.99 USD).
Two short lengths of 20 ga. Wire (in some units - 18 ga. Wire will suffice). Two solder less connectors (butt joints - also available at Radio Shack). Solder less connector crimping tool (pliers can be used if you are careful).
Soldering Iron. Flux Core SolderInstallation of this volume control will void some sellers warranty on the soundsystem and associated parts. DO NOT OPERATE MACHINE WITH SOUNDPachislo Slot Machine Ver.
1.018TURNED ALL THE WAY DOWN. THIS CAN POTENTIALLY OVERHEATTHE AMPLIFIERS.4.8 Cleaning & Polishing Your SlotFor Cleaning the outside Plastic parts of your Slot Machine, I use both NOVUS#1Plastic Clean & Shine as well as Kleenmaster Brillianize. Both of these areextremely safe for plastics, but they also add a nice shiny glaze to your plasticparts on your slot machine.
They can also remove very small scuff marks.Novus Plastic Polish No. 1 (1-800-548-6872) gently cleans all plastics withoutscratching. It leaves a lustrous shine that resists fogging, repels dust, andeliminates static. It also protects against smudges and scratching.Directions — First, Remove surface dust with soft cloth.
Second, Shake Novusbottle well, and apply a light mist of polish. Third, Spread the spray evenly overthe entire surface of the plastic parts of the slot machine with a clean, soft, lint-free cloth. And finally, Buff with a clean, soft, lint-free cloth.
This helps your slotresist dust! Also works great on other plastic parts around your home!Kleenmaster Brillianize (www.brillianize.com 1 1-707-751-0656) makes yourplastics surfaces brilliant - anti-static, repells dust and resists scratching &fingerprints. It is Alcohol & Amonia-Free and Non-Toxic! Originally made formotorcycle windshields - it works great on slot plastics!Directions Shake Container. Apply evenly to any hard, shiny, non-absorbentsurface at room temperature. Rub gently with a Soft Cloth.
Before surface dries,polish with a dry soft cloth or similar non-damaging material, until the surfacefeels 'as smooth as ice '. I highly recommend using an old cotton t-shirt - worksgreat for polishing!Pachislo Slot Machine Ver. 1.0 194.9 Removing Scratches from your Slot MachineI highly recommend Novus 2 for Fine Scratch Removal or Novus 3 for moreabrasive scratch remover. These are abrasive - but you use them as if you werepolishing and removing scratches from your car.
Novus #2 is for fine scratchesand abrasions, and Novus #3 is for larger scratches. If you use Novus #3 - youwill then have to use Novus #2 and #1 in that order to polish out to a clearbrilliant shine. Be sure to read the complete instructions as well as the warning. Iam not responsible if you mess up.
However, it is quite easy to do and it is thesystem most of the slot restorers use. You can find these at most stores that handleplastics - but I recommend you do a googlesearch for the item and compare prices - there is quite a difference in prices forthese polishes. You should be able to get a bottle for about $4 each if you shopwisely on the internet.5.0 Convert Your Machine to Accept QuartersIt is the owner's responsibility to determine if it is legal in your state/county toconvert your machine to accept quarters.Due to the fact that some coin hoppers can't handle quarters, only the followingbrands can be converted successfully:Universal/ Aruze/Macy/Mizuho/Electrocoin/Yamasa/Olympia/Heiwa/Daido/NETAll quarter conversions are done at the owner's risk. We do not guarantee that anymachine can successfully be converted to accept quarters. We have only listed thebrands above because we have had success in their conversion. Any damagecaused by a failed conversion is the owner's responsibility.Determine the Coin Mechanism Type from the 3 main types of coin mechanismsbelow and follow the instructions for that type:Pachislo Slot Machine Ver.
1.020Type A - Universal/Electrocoin/Eleco/Macy/Aruze- » »TYPE ATypeBPachislo Slot Machine Ver. 1.0C - Olvmpia, Heiwa Machines215.1 Type A - Universal/Electrocoin/Eleco/Macy/AruzeConversion:1) Remove the Coin Deflector (Squeeze the sides gently and pullout).2) Remove the Coin Mechanism. Push the metal handle on the left hand side ofthe coin mechanism up until you can see that the coin mechanism has beenreleased. Pull out on the left hand side of the mechanism. Remove fromthe machine.Pachislo Slot Machine Ver. 1.0 223) Unplug the Coin Mechanism from the Circuit Board.4) Loosen the Coin Track Screws on the Coin Mechanism.
On the back side ofthe coin mechanism, loosen those two screws a couple of turns.5) Slide the coin Track Up. Turn the coin mechanism over.
There is a spring-loaded cover on this side. Move it up and out of the way. You will notice a metalcoin track that the coin rolls over. Move the coin track up and in line with theopening on the spring loaded cover. Move it slightly down from that point bytapping it down. Tighten screws that were loosened earler.6) Reassemble in the reverse order of the removal steps.
Power machine up withthe door open. Insert quarters in the coin slot and catch them on the inside withyour hand. If the quarters are not rejected into the coin tray, yourconversion was successful. These types of machines will accept quarters andtokens once the conversion is completed. If this If the coin is rejected, go back toStep 4 and redo step 4, 5 and 6.5.2 Type B Conversion:1) Follow the wiring harness from the coin mechanism - hold the circuit boardand unplug the wiring harness.2) Using a Phillips head screwdriver, remove the two screws thatsecure the coin mechanism to the door.
Be careful not to drop the screws. You canuse a magnetized screwdriver — however be careful around the circuit board toprevent damage to the circuit board from the magnetized screwdriver.Pachislo Slot Machine Ver. 1.0 233) Shim the Quarter drop area since a quarter is slightly smaller in diameter than atoken. There is a window in the back of the coin mechanism that will cause aquarter to fall through the coin mechanism and return to the coin tray.
Cut the endoff of a small zip tie and put double sided tape on one side. Clean the area of thecoin mechanism with denatured or rubbing alcoholand stick the zip tie under the hole in the back of the coin mechanism.4) Test it with a real quarter. Holding the coin mechanism at an angle, put aquarter in the entry and check that id won't fall through.
IntroductionThe plantaris is a small muscle that courses along the posterior aspect of the leg as part of the posterosuperficial compartment of the calf. Often thought of as a vestigial, accessory muscle, the plantaris muscle is absent in only 7–20% of limbs. Although injuries of this structure have been a source of controversy, pathology of the plantaris muscle and tendon is an important differential diagnosis for pain arising from the proximal posterior aspect of the leg.The purpose of this paper is to outline the anatomy, injury, diagnostic imaging, and treatment of the plantaris muscle. As well, it is intended to highlight the importance of including injury of this structure as a reasonable differential diagnosis for proximal posterior leg pain. AnatomyThe plantaris muscle consists of a small, thin muscle belly, and a long thin tendon that forms part of the posterosuperficial compartment of the calf. Together with the gastrocnemius, and soleus, they are collectively referred to as the triceps surae muscle.
The muscle originates from the lateral supracondylar line of the femur just superior and medial to the lateral head of the gastrocnemius muscle as well as from the oblique popliteal ligament in the posterior aspect of the knee., The muscle ranges from 7 to 13 cm long varying highly in both size and form when present. From its origin, the muscle courses distally in an inferior and medial direction across the popliteal fossa. At the level of the proximal third of the leg, the muscle belly is situated between the popliteus muscle anteriorly, and the lateral head of the gastrocnemius muscle posteriorly.
The myotendinous junction occurs approximately at the level of the origin of the soleus muscle from the tibia in the proximal portion of the lower leg. The long thin tendon forms part of the medial border of the muscle belly as it courses between the medial head of the gastrocnemius muscle and the soleus muscle in the midportion of the leg. On cadaveric dissection, this long, slender tendon is easily mistaken for a nerve and hence has been dubbed by some the “freshman’s nerve.” It continues inferiorly along the medial aspect of the Achilles tendon, which it accompanies to its insertion on the calcaneus.
Anatomic studies have shown that the calcaneal insertion may also occur independently of the Achilles tendon. This is of interest as the plantaris tendon often remains intact when the Achilles tendon ruptures. Neural innervation is common to all three muscles of the triceps surae group and is provided by the tibial nerve (S1, S2). Location of the plantaris in the popliteal fossa: a) demonstrates plantaris (P) deep to the lateral head of the gastroc b) demonstrates the plantaris (P) with the gastroc removed The plantaris is superficial to the popliteus muscle.
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(Published with permission from Primal Pictures © 2004)In terms of function, the plantaris muscle acts with the gastrocnemius but is insignificant as either a flexor of the knee or a plantarflexor of the ankle. It has been considered to be an organ of proprioceptive function for the larger, more powerful plantarflexors as it contains a high density of muscle spindles.Palpation of the muscle belly is possible in the popliteal fossa as well as along the medial aspect of the common tendon of the triceps surae group. With the patient prone and the leg flexed to approximately 90 degrees, the distal hand of the practitioner covers the heel while the forearm is applied against the plantar aspect of the foot, allowing a simultaneous resistance to plantarflexion of the foot and flexion of the knee. The muscle is palpated in the popliteal fossa, medial and superior to the lateral head of the gastrocnemius muscle. Its tendinous portion can be palpated along the medial aspect of the Achilles tendon into its calcaneal insertion. InjuryDespite its small size, injuries of the plantaris muscle and tendon, which have been termed “tennis leg,” have been a source of controversy in the literature., Tennis leg is a relatively common clinical condition.
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In the past it has been described as being caused by various etiologies including plantaris tears, medial head of gastrocnemius tears, soleus tears, or a combination thereof. The injury occurs most frequently during running or jumping and usually results from an eccentric load placed across the ankle with the knee in an extended position. Even though the injury is the result of an indirect mechanism, subjectively the patient may describe direct trauma to the calf region – often the athlete feels as though they were struck on the calf by an object such as a ball or piece of equipment. Depending on the severity, calf soreness may be experienced that may cause the athlete to stop play, or may simply be experienced throughout the remainder of the activity. This pain usually becomes more severe after resting or the next day. Accompanying the pain may be swelling that may extend down to the ankle and foot.
Any attempt at active or passive dorsiflexion, and resisted plantarflexion with elicit severe pain.,The etiology of “tennis leg,” and the existence of an isolated rupture of the plantaris muscle as the cause, has been debated since Powell first described this clinical condition in 1883. Arner and Lindholm rekindled the debate in 1958, followed by Miller in 1977, as well as Severance and Bassett in 1982, all of whom concluded that isolated rupture of the plantaris was not the cause of this clinical condition.
In fact, Miller described this etiology as an “intellectual hoax.”It has now been established through the use of MR imaging, sonography, and surgical exploration, that injuries to this muscle may in fact occur in isolation, as well as in association with tears of the gastrocnemius, soleus, and ACL (Anterior Cruciate Ligament). Allard et al. Were the first to demonstrate ruptures of the plantaris muscles of two patients. One was demonstrated on MR imaging, and the other on diagnostic ultrasonography. Later, Helms et al. Examined the MR images of fifteen patients with sports-related injuries to the lower leg.
The plantaris muscle and tendon, as well as the surrounding structures, were retrospectively examined for abnormalities. In all fifteen patients, evidence of rupture or strain of the plantaris muscle was present.
An associated torn anterior cruciate ligament (ACL) was found in 10 of 15 patients. Five injuries were isolated or associated with partial tears of the gastrocnemius or popliteus muscle.The first surgically confirmed isolated rupture of plantaris was documented by Hamilton et. They reported a case of a 40-year-old women who was seen in the emergency room with a 7-day history of pain and swelling in her calf region after stepping off a curb and feeling a “pop.” After discovering a fusiform mass measuring 5 × 2 cm in the greatest transverse dimensions lying between the medial head of gastrocnemius and the soleus on MR imaging, an excisional biopsy was performed on an elective basis in fear of the existence of an underlying neoplasm. A gray white, well-circumscribed mass, later shown to be a benign resolving hematoma, was discovered along with a complete tear of the plantaris muscle at its musculotendinous junction. No associated damage of the gastrocnemius or soleus was found again demonstrating the possibility of an isolated plantaris rupture causing this clinical condition.Delgado et al.
In 2002 retrospectively reviewed sonographic findings in 141 patients referred with a clinical diagnosis of tennis leg. Findings included rupture of the medial head of the gastrocnemius muscle in 66.7% of the sample, fluid collection between the aponeuroses of the medial gastrocnemius and soleus muscles without muscle rupture in 21.3%, sole rupture of the plantaris tendon in 1.4%, and partial rupture of the soleus muscle in 0.7%. These findings suggest that the etiology of tennis leg can be caused by injury sustained by various tissues in isolation, or in combination.Thus the literature demonstrates that injury to the plantaris muscle either on its own, or in combination with gastrocnemius, or soleus damage, can represent the cause of the clinical condition known as tennis leg. This etiology however is not as common as gastrocnemius injury, which is highly susceptible due to its superficial location, predominance of type II fibers, eccentric muscle action, and extension across two joints.Findings related to deep venous thrombosis in the calf can be mistaken for those of tennis leg and thus must be kept in mind in the differential diagnosis of clinical findings suggestive of this condition., Other differentials may include a ruptured Baker’s cyst, and calf neoplasms. ImagingMagnetic resonance (MR) imaging and ultrasonography (US) have been used as the primary imaging techniques for evaluation of patients with the clinical diagnosis of non-specific posterior lower leg pain. The importance of imaging patients with this condition is to rule out more serious conditions such as deep venous thrombosis., In addition, imaging can be used to evaluate the location and extent of the muscle injury; however, treatment of this injury does not depend on these findings.
T1 weighted images of the knee indicating the plantaris muscle: a) T1 coronal image demonstrating the plantaris (normal) b) T1 axial image. (Published with permission from Primal Pictures © 2004)The appearance of plantaris muscle injury on MR images depends on the severity of the muscle strain. An abnormally high signal intensity may be seen both within, and adjacent to the muscular fibers of the plantaris muscle at the level of the knee joint, or at the myotendinous junction on T2-weighted images. In proximal injuries to the middle of the muscle belly, high signal may involve the plantaris muscle on its own, or it may also involve structures adjacent to the muscle in the posterolateral aspect of the knee. This type of plantaris strain can be seen in association with anterior cruciate and arcuate ligament injury, as well as with lateral compartment bone contusions. Complete plantaris rupture, which most often occurs at the myotendinous junction, results in proximal retraction of the muscle, which may appear as a mass located between the popliteus tendon anteriorly and the lateral head of the gastrocnemius posteriorly.
The mass may demonstrate high signal intensity on T2-weighted and fat-suppressed images in the acute setting unless it is ruptured completely through the mid-substance of the tendon. In the acute setting, an intermuscular hematoma between the soleus muscle and the medial head of the gastrocnemius may also be seen.Using sonography, the muscle belly of the plantaris muscle is initially located in the proximal calf region using a transverse scan. It is readily appreciated as a triangular structure having the soleus muscle as its base and the medial and lateral bellies of the gastrocnemius as it sides. While utilizing the transducer in a transverse fashion it is possible to follow the muscle from its most proximal attachment on the lateral femoral condyle, down to the myotendinous junction at the level of the fibular head.
Because the tendon forms the medial border of the belly, it is seen on the transverse scan as a subtle thickening at the medial corner of the triangular belly. Distal to the myotendinous junction, the tendon is generally not visualized well in the transverse plane.The fiber orientation of the plantaris muscle belly and tendon is best visualized by rotating the transducer to a longitudinal direction along the axis of the muscle. In this fashion, the plantaris is visualized as a thin muscle encased in an independent epimysium layer between the bellies of the gastrocnemius and soleus. This fibrillar pattern of both the muscle and tendon is, in most individual’s, well depicted.Rupture of the plantaris will demonstrate discontinuity of the muscle or tendon on longitudinal scanning. Fluid usually accumulates (creating a hypoechoic area) in a tubular configuration between the medial head of the gastrocnemius and the soleus muscle bellies, along the course of the plantaris. Fluid collections associated with the plantaris are sometimes seen even when no muscle or tendon tear is seen. Helms et al demonstrated using MR imaging that fluid may be associated with plantaris strains and further to this, Leekham et al concluded that when such fluid collections are seen in patients with a strong clinical suspicion for plantaris injury, a diagnosis of plantaris strain is appropriate if no tear is seen.
TreatmentAlthough an there are no studies specifically looking at the treatment of plantaris injury, early literature on “non-specific” tennis leg has stated that simple conservative treatment is effective, and that permanent disability rarely results. This idea is mirrored in more recent papers that agree that conservative therapy is effective., However the lone study done on treatment of non-specific posterior calf musculature strains that can support these claims was a retrospective study done by Millar in 1979. This study was performed on a series of 720 patient cases, over a 12-year period. The treatment routine included pain relief throught the use of cryotherapy and passive stretching, followed by a 5-min period of ultrasound therapy. Treatment then progressed to strengthening exercises for the antagonists and later the agonists, and quadriceps exercises.
This treatment protocol was considered effective as evidenced by a recurrence of the condition in only 0.7% of the patients. As it was a retrospective study, no control group was utilized and no other treatment regimen was considered. The extent of the muscular injury, or grade of the tear, was also not considered.
Thus there is a paucity of evidence guiding clinicians as to the most effective form of treatment.To overcome the absence of literature concerning the topic, the practitioner may turn to the literature concerning the treatment of muscle injuries in general in order to establish an evidence based treatment protocol. However, when examining the literature regarding the management of muscular injury, it is surprising to find that the current treatment principles of injured skeletal muscle lacks firm scientific basis. Only a few clinical studies exist on the treatment of muscle injury, and thus, the current treatment principles are primarily based on experimental studies or empirical evidence. Even the basic management of acute injury using the rest, ice, compression, and elevation principle (RICE) protocol lacks scientific examination.
In fact there are no randomized clinical trials to prove the effectiveness of the RICE principle in the treatment of soft tissue injury. Thus Recent advances in treatment approaches have in large part come from studies that have correlated basic science principles with clinical observation. When broken down into its histological components, treatment of muscle injury in the acute phase should include preventing further damage, controlling the inflammatory cascade, limiting pain in order to promote early mobilization. Later, proper repair and regeneration of both muscle tissue, and its connective tissue components become the focus of treatment, as excessive fibrosis scar-tissue formation is one of the major factors that can slow muscle healing. After that, strengthening, proprioceptive rehabilitation, and in athletes, sport specific rehabilitation becomes paramount.The immediate treatment of muscle injury involves the RICE (rest, ice, compression, elevation) protocol. Although, as stated prior, no direct evidence exists for this protocol, there is scientific evidence for the appropriateness of the distinct components of the concept. In terms of the resting component, a brief period of immobilization is needed in order to allow the body to provide new granulation tissue with the needed tensile strength to withstand the forces generated by muscle contractions., The position of immobilization is also an important factor that can influence healing.
ConclusionOften dismissed as a small, vestigial muscle, injury of the plantaris muscle should actually be included in differential considerations of the painful calf. Injury to the plantaris muscle may occur at the myotendinous junction with or without an associated hematoma, or partial tear of the medial head of the gastrocnemius or soleus. A strain of the more proximal plantaris muscle belly may also occur as an isolated injury, or in conjunction with injury to the adjacent ACL. As proper management for muscular injury in general is scarce, it is not surprising that the literature is lacking with regards to the proper management of plantaris injury. Also lacking in the literature is a solid understanding as to the role that the plantaris plays in functional mechanics.
Further research is needed in order to assess its importance to mechanics as well as its role in other conditions affecting the knee.