Muscle Herniation

One of the more common injuries to occur in the lower leg is a muscle hernia. A muscle hernia is a focal protrusion of a muscle through a small defect in the

Lower Leg Herniation
Fig. 29. Axial T2 image showing large soleus hematoma and lower extremity enlargement with muscle edema consistent with clinical finding of compartment syndrome (arrow).
Chronic Compartment Syndrome Mri
Fig. 30. Patient with chronic compartment syndrome as a result of a large hemangioma seen on these post contrast axial T1-weighted images (arrow).

fascial plane [133,134]. The anterior compartment is more commonly involved particularly the tibialis anterior and, to a lesser extent, the extensor digitorum longus, and the peroneus muscles [133]. Hernias can be associated with trauma or muscle hypertrophy and may be painful. [18]. When there is a history of trauma, it is usually from penetrating wounds or violent impact [133]. The diagnosis of a muscle hernia is generally a clinical one, based on symptoms and physical examination. A small superficial bump may be noted with the limb at rest, which will become more prominent with contraction of the associated muscle. If the clinical picture is not clear, an MRI may show a focal protrusion of muscle through the fascial defect, however dynamic imaging muscle contraction can make the herniation more conspicuous. It is critical for the interpreting radiologist to mark the area of concern with a vitamin E capsule or visually inspect the leg, as these findings may be subtle with MRI (Fig. 31). It is also important to exclude underlying true tumors.

Treatment of muscle herniations, especially when asymptomatic, is conservative, although fasciotomy may be performed for cosmetic reasons. Fascial repair is no longer performed as this may result in compartment syndrome [133]. Herniation may rarely result in muscle necrosis as a result of strangulation [10].

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