Surgical Repair of Tibialis Anterior Muscle Herniation Using a Synthetic Mesh That Was Beneath the Fascia after a Military Training Program: A Case Report

Tibialis anterior muscle herniation is the most common type of skeletal muscle herniation of the lower legs. The treatment of muscle herniation relies on the patient's symptoms. For patients with chronic large fascial defects, fascial grafting with synthetic mesh can be considered. In this case of a patient who was exposed to excessive strain on his lower legs during a military training program, the use of a secure repair technique with synthetic mesh was required. This paper presents a case of tibialis anterior muscle herniation that was treated successfully with a monofilament knitted polypropylene mesh covered by the tibialis anterior fascia. The advantages of this technique include early rehabilitation and an early return to work. No significant difference in the clinical results compared to other methods were observed and there were no complications. The military training program appeared to have aggravated the patient's symptoms of tibialis anterior muscle herniation. On the other hand, larger scale study will be needed to determine if this program actually affects the clinical outcomes.

Sonographic Demonstration of a Gastrocnemius Fascial Defect: A Rare Cause of Calf Pain / Demostración sonográfica de un defecto fascial del gastrocnemio: una causa rara del dolor de pantorrilla

ABSTRACT Fascial defects with muscular herniation are an uncommon, treatable cause of calf pain. Differential diagnosis includes deep vein thrombosis, compartment syndrome, soleus strain/tear, and muscle or subcutaneous tumour. In this case, sonography was more sensitive for diagnosis than magnetic resonance imaging.

RESUMEN Los defectos fasciales con herniación muscular son una causa poco frecuente y tratable del dolor de pantorrilla. El diagnóstico diferencial incluye trombosis venosa profunda, síndrome compartimental, distensión o desgarro del sóleo, y tumor subcutáneo o muscular. En este caso, la sonografía resultó más sensible para el diagnóstico que la tomografía por resonancia magnética.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

The Use of Dynamic Ultrasonography for the Confirmation of Lower Leg Muscle Herniation

The term muscle herniation represents focal muscular protrusions through an acquired or congenital fascial defect. The anterior tibialis muscle is the most common site of herniation. Dynamic ultrasonography has become an important tool in dermatology for diagnosing suspected muscle herniation because it is a non-invasive, highly accurate, readily available and cost-effective imaging technique. We present here the case of a 21-year-old male Korean soldier who underwent dynamic ultrasonography to confirm the diagnosis of anterior tibialis muscle herniation.