Transfascial muscular hernia: An unusual cause for a “hide and seek” subcutaneous nodule

Lower Leg Muscle Hernia: A Systematic Review

“…Of note, no specific predictive factors for bilateral involvement were found on qualitative analysis. Compartment involvement was noted in 14 studies (19 patients) [1][2][3][6][7][8][9][10][11][12][13][14][15], consisting of predominantly anterior compartment muscle herniation (78.9%) [1,2,6,[9][10][11][12]14,15], followed by lateral compartment (10.5%)8 and superficial posterior compartment (10.5%) [3,13]. The present case report is the only study which involves bi-compartmental muscle herniation in the lower leg.…”

“…Superficial peroneal nerve involvement was rare, and diagnosed either sonographically or intraoperatively in only 10.5% of patients across 4 studies, including the present case report [4,8,16]. Fascial weakening at the point of muscle herniation was detected in 36.8% of included patients, either through radiological means or surgical exploration [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. One study primarily focused on results of surgery and clinical management flowchart without reporting evidence of fascial weakening [16].…”

“…The weighted average age of presentation was at 28.8 years of age (SD, 3.4 years; 95% CI, 21.5 to 36.1 years). 11 out of 17 studies reported patients with history of manual labour or engagement in sporting activities [1][2][3][4][5][6][7][8][9][10]. 3.5% (n = 2) of the total study population were military service members [8,9].…”

“…The present case report is the only study which involves bi-compartmental muscle herniation in the lower leg. Herniation of the tibialis anterior muscle was predominantly found in younger patients (< 35 years old) [1,2,[9][10][11][12]14,15], as compared to older patients (>35 years old) who experienced herniation of varying muscles (e.g. soleus, peroneus, gastrocnemius) [3,6,8,13].…”

“…Conservative management of muscle hernia was adopted in 5 case reports [1,3,7,9,10], with the primary methods of conservative management including rest from strenuous exercise, icing of affected site, prescription of compression garments, oral analgesics, and physical therapy. Similar to the present case report, 2 studies reported failure of conservative management which presented in the form of pain recurrence and/or repeated mass protuberance, requiring conversion to surgery [7,9].…”