- Muscle herniation, although rare, can present with continuous pain and swelling
- Often after an injury such as an ankle sprain
A 42-year-old man presented to the hospital with a complaint of persistent pain in his leg. He reported twisting his right lower leg, two months ago. The injury developed while climbing the stairs and resulted in immediate immobilization.
Doctors treated him with a conservative approach using weight bearings and compression stockings. However, the pain did not subside. Therefore, surgical intervention was needed.
Investigations Reveal Herniation
Prior to planning the surgery, doctors conducted extensive investigations to determine the cause of pain and swelling. The pain originated at the medial right lower calf, i.e., in the medial gastrocnemius muscle. This area was tender with an enlarged circumference as compared to the opposite leg.
Doctors also measured the compartmental pressure which showed slight elevation at the affected region. Furthermore, a bulge in the region suggested muscle deviation due to a facial defect. Doctors operated on him under general anaesthesia. They used a longitudinal incision to access the gastrocnemius muscle. After reducing the fascial defect, they placed the herniated muscle back to its original position using a mesh. Post-operatively, doctors kept the patient on a course of analgesics and anti-inflammatory medicines along with a leg cast and restricted physical activity.
Muscle Herniation: Can it Cause Clinical Symptoms?
Muscle herniation often occurs secondary to fascial rupture following a sports injury. Most commonly herniated muscles are those of the anterior leg, especially the tibialis anterior. However, they seldom present with symptoms. Furthermore, herniation of gastrocnemius muscle is highly rare with this being perhaps the only case to date.
A herniated muscle can also be confused with a tumour especially when the presentation is late. In all such cases, a detailed patent history plays a key role in the diagnosis. Moreover, it is essential to look for associated neurological symptoms, for example, loss of sensations (hyposensitivity), which usually arise due to compression of nerves by the herniated muscle.
