Muscle hernias of the leg: A case report and comprehensive review of the literature

Abstract

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.

Keywords: Leg; Muscle hernia; Peroneus brevis; Review.

Figure 1)

Magnetic resonance imaging of the left lower extremity T2 coronal plane. A skin marker had been placed directly over the peroneal musculature and demonstrated a focal contour irregularity on the anterior aspect, consistent with a fascial defect and herniation of peroneus brevis (arrow)

Figure 2)

Intraoperative photographs. A and B Left lower extremity lateral incision with exposed peroneus brevis muscle and proximal aspect of the fascial defect (instrument). The superficial peroneal nerve has been dissected free from the proximal deep fascia and completely released (white vessel loop). C Longitudinal lateral compartment fasciotomy has been performed from the proximal and distal edges of the fascial defect using scissors, and has released the deep fascia of the left leg lateral compartment