Skip to main content

Multimodality evaluation of transfascial muscle and other soft tissue herniations of the extremities

Abstract

This review illustrates the multimodality assessment of transfascial muscle and other soft tissue herniations of the extremities. Transfascial herniations of the extremities can develop from congenital or acquired disruptions of the deep fascia, resulting in herniation of the underlying muscle, nerve, or soft tissue tumor into the subcutaneous tissues. While most patients present with a painless subcutaneous nodule that may change in size with muscle activation, some may experience focal or diffuse extremity symptoms such as pain and paresthesias. Although the diagnosis may be clinically suspected, radiologic evaluation is useful for definitive diagnosis and characterization. Ultrasound is the preferred modality for initial workup through a focused and dynamic examination. Magnetic resonance imaging can be utilized for equivocal, complicated, and preoperative cases. Computed tomography is less useful in the evaluation of transfascial herniations in the extremities due to similarities in the attenuation between muscle and fascia, which can decrease the conspicuity of small defects.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. Clinite KL, Wyble A, Sugarman JL. Tibialis anterior muscle herniation in adolescents: a case series and review of the literature. Pediatr Dermatol. 2019;36(5):664–7. https://doi.org/10.1111/pde.13875.

    Article  Google Scholar 

  2. Hullur H, Salem Y, Al Khalifa J, Salem A. Tibialis anterior muscle hernia: rare but not uncommon. BMJ Case Rep. 2016;2016:bcr2016217569. https://doi.org/10.1136/bcr-2016-217569.

    Article  Google Scholar 

  3. Kendi TK, Altinok D, Erdal HH, Kara S. Imaging in the diagnosis of symptomatic forearm muscle herniation. Skeletal Radiol. 2003;32(6):364–6. https://doi.org/10.1007/s00256-002-0615-8.

    Article  Google Scholar 

  4. Nguyen JT, Nguyen JL, Wheatley MJ, Nguyen TA. Muscle hernias of the leg: a case report and comprehensive review of the literature. Can J Plast Surg. 2013;21(4):243–7.

    Article  Google Scholar 

  5. Flores DV, Mejía Gómez C, Estrada-Castrillón M, Smitaman E, Pathria MN. MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics. 2018;38(1):124–48. https://doi.org/10.1148/rg.2018170072.

    Article  Google Scholar 

  6. Kim JY. Herniation of a lipomatous tumor in the extremity: a report of 3 cases. J Korean Radiol Soc. 2007;57:175–9.

    Article  Google Scholar 

  7. Foresti M. Superficial peroneal nerve compression due to peroneus brevis muscle herniation. J Radiol Case Rep. 2019;13(11):10–7. https://doi.org/10.3941/jrcr.v13i11.3757.

    Article  Google Scholar 

  8. Fustà-Novell X, Morgado-Carrasco D, Iranzo P, Giavedoni P. Transfascial muscular hernias: diagnosis by dynamic ultrasonography. Sultan Qaboos Univ Med J. 2019;19(3):e264–6. https://doi.org/10.18295/squmj.2019.19.03.016.

    Article  Google Scholar 

  9. Sharma N, Kumar N, Verma R, Jhobta A. Tibialis anterior muscle hernia: a case of chronic, dull pain and swelling in leg diagnosed by dynamic ultrasonography. Pol J Radiol. 2017;82:293–5. https://doi.org/10.12659/PJR.900846.

    Article  Google Scholar 

  10. Lane JE, Woody CM, Lesher JL. Tibialis anterior muscle herniation. Dermatol Surg. 2002;28(7):641–2. https://doi.org/10.1046/j.1524-4725.2002.01304.x.

    Article  Google Scholar 

  11. Khaladkar SM, Kondapavuluri SK, Kamal A, Kalra R, Kamal V. Detection of myofascial herniation on dynamic sonography and magnetic resonance imaging. Case Rep Radiol. 2016;2016:4245189. https://doi.org/10.1155/2016/4245189.

    Article  Google Scholar 

  12. Bergmann G, Ciritsis BD, Wanner GA, Simmen HP, Werner CM, Osterhoff G. Gastrocnemius muscle herniation as a rare differential diagnosis of ankle sprain: case report and review of the literature. Patient Saf Surg. 2012;6(1):5. https://doi.org/10.1186/1754-9493-6-5.

    Article  Google Scholar 

  13. Ihde H. On muscular hernia of the leg. Acta Chir Scand. 1929;65:97–120.

    Google Scholar 

  14. Sanders BS, Bruce J, Robertson J. Treatment of a symptomatic forearm muscle herniation with a mesh graft. Sports Health. 2011;3(2):179–81. https://doi.org/10.1177/1941738111398616.

    Article  Google Scholar 

  15. Mellado JM, Pérez del Palomar L. Muscle hernias of the lower leg: MRI findings. Skeletal Radiol. 1999;28(8):465–9. https://doi.org/10.1007/s002560050548.

    Article  CAS  Google Scholar 

  16. Kramer DE, Pace JL, Jarrett DY, Zurakowski D, Kocher MS, Micheli LJ. Diagnosis and management of symptomatic muscle herniation of the extremities: a retrospective review. Am J Sports Med. 2013;41(9):2174–80. https://doi.org/10.1177/0363546513493598.

    Article  Google Scholar 

  17. Hallinan JTPD, Smitaman E, Huang BK. Dynamic ultrasound imaging of peroneus longus muscle herniation: a case report and review of the literature. Am J Phys Med Rehabil. 2019;98(7):e69–70. https://doi.org/10.1097/PHM.0000000000001099.

    Article  Google Scholar 

  18. Beggs I. Sonography of muscle hernias. AJR Am J Roentgenol. 2003;180(2):395–9. https://doi.org/10.2214/ajr.180.2.1800395.

    Article  Google Scholar 

  19. American College of Radiology. ACR Appropriateness Criteria®. Available at https://acsearch.acr.org/list. Accessed 18 Apr 2022.

Download references

Acknowledgements

The authors thank Sonia Watson, Ph.D. for assistance in preparation of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francis I. Baffour.

Ethics declarations

Ethics approval

All procedures in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Approval from the Institutional Review Board was obtained. In keeping with the policies for a review, informed consent was not required.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pitot, M.A., Powell, G.M., Holcomb, R. et al. Multimodality evaluation of transfascial muscle and other soft tissue herniations of the extremities. Skeletal Radiol 52, 1–8 (2023). https://doi.org/10.1007/s00256-022-04121-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-022-04121-6

Keywords

  • Muscle herniation
  • Extremity
  • Fascial defect
  • Ultrasound
  • MRI