Abstract
Herniation of muscle tissue through a defect in the fascial sheath is rare; it is extremely uncommon for a patient to present in a clinic with a symptomatic muscle hernia. The usual presentation of a tibialis anterior muscle herniation is a bulge seen at the level of a fascial defect which decreases in size or disappears when the muscle contracts. We report an abnormal presentation of a tibialis anterior herniation in which the herniation swelling became more prominent on muscle contraction instead of diminishing. It is hypothesized that an increased pressure in leg compartment leads to a partially avascular and less responsive posterior portion of tibialis anterior muscle. This fixed volume of non-contracting muscle is then pushed out through the fascial defect during active muscle contraction. The herniation in this particular case was treated by enlarging the fascial defect. No recurrence was noted in a 12 months follow-up.
Résumé
La hernie musculaire à travers une brèche aponévrotique est rare; il est encore plus rare que cette hernie devienne symptomatique. Habituellement la hernie du muscle tibial antérieur se présente sous forme d’une tuméfaction qui diminue de taille ou disparaît lors de la contraction musculaire. Nous présentons un cas atypique de hernie tibiale antérieure qui se majorait lors de la contraction musculaire. L’hypothèse que nous formulons est que l’augmentation de pression intra-compartimentale a conduit à une dévascularisation partielle du muscle tibial antérieur; cette portion musculaire devenue moins contractile se trouvait expulsée à travers la brèche aponévrotique lors de la contraction musculaire. Le traitement a consisté en un élargissement de la brèche. Le résultat est correct à un an de recul.
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Agarwal, A., Agarwal, R. Abnormal presentation of tibialis anterior herniation. Eur J Orthop Surg Traumatol 16, 271–272 (2006). https://doi.org/10.1007/s00590-005-0072-x
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DOI: https://doi.org/10.1007/s00590-005-0072-x