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Maffulli N, Quaranta M, Poeta N, Oliva F, Padhiar N, Chan O. Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia. Surgeon 2023; 21:e63-e70. [PMID: 35168905 DOI: 10.1016/j.surge.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Symptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport. METHODS The study reports mid-term results in a series of 22 consecutive patients (17 males and 5 females, median age: 22 years) with a unilateral tibialis anterior MH who had undergone minimally invasive fasciotomy between 2008 and 2019. Clinical outcomes were assessed with SF-36 and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery, and the time to return to training (RTT) and to sport (RTS) were recorded. RESULTS At a median follow up after surgery of 23 months, both questionnaires showed a statistically significant improvement (P < 0.005). At the latest follow up, 16 of patients (73%) had returned to pre-injury or higher levels of sport/activity. The median time to return to training and to return to sport was 7 and 11 weeks respectively. No severe complications and no recurrence of symptoms were recorded. CONCLUSION Minimally invasive fasciotomy is effective and safe for patients suffering from muscle hernia of the tibialis anterior muscle with good results in the mid-term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK; School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK.
| | - Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Nat Padhiar
- The London Independent Hospital, London, UK.
| | - Otto Chan
- Department of Medical Imaging, The London Independent Hospital, London, UK.
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2
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Meyers AB, Epelman M. Ultrasound versus magnetic resonance imaging of soft-tissue lesions: competitive or complementary? Pediatr Radiol 2022; 52:1639-1647. [PMID: 35122484 DOI: 10.1007/s00247-021-05274-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
Soft-tissue lumps and bumps are a common referral for imaging in children and adolescents. The etiology of these lesions includes benign non-tumorous lesions, as well as benign and malignant tumors. Some of these lesions have a characteristic imaging appearance but others do not and require tissue sampling to make a diagnosis. MRI typically provides the best overall characterization of soft-tissue masses; however, in some cases US provides complementary information to that provided by MRI that can help make a diagnosis.
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Affiliation(s)
- Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH, 45229, USA.
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
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3
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Quaranta M, Poeta N, Oliva F, Maffulli N. Muscle herniae: Conservative and surgical management. Systematic review. Surgeon 2022; 21:181-189. [PMID: 35292215 DOI: 10.1016/j.surge.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Muscle herniae are often unrecognized. The primary objective of this systematic review is to evaluate the outcomes of conservative and surgical management for muscle herniae. The secondary objective is to define the most appropriate management for muscle herniae depending on aetiology and size of the fascial defect. METHODS The PRISMA guidelines were used to organize this systematic review to assess the different management modalities and identify possible criteria useful to guide the management of muscle herniae. An electronic search of PubMed and Scopus databases was performed. RESULTS A total of 132 patients were identified. Conservative management was carried out in 22 (16.7%) patients, and 110 (83.3%) patients underwent surgical procedures. Pain was reported in 3/22 (13.6%) patients managed conservatively. Post-surgical pain was reported in 0/5 (0%) patients treated with autologous graft repair, 1/15 (6.7%) patient with mesh repair, 2/13 (15.4%) patients with direct repair and 11/77 (14.3%) patients with fasciotomy. Return to normal activity was possible in 16/22 (72.7%) patients treated conservatively, 5/5 (100%) patients undergoing autologous graft repair, 13/15 (86.7%) with mesh repair, 62/77 (80.52%) with fasciotomy and 4/12 (33.3%) with direct repair. CONCLUSION In congenital muscle herniae, fasciotomy should be considered the surgical choice to prevent complications. In post-traumatic muscle hernia, a small fascial defect can be treated with the direct suture repair, while mesh repair and autologous graft repair should be considered the most appropriate procedures to avoid severe complications such as compartment syndrome.
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Affiliation(s)
- Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK.
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4
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Periosteal Rotation Flap Technique in Management of Tibialis Anterior Muscle Hernia: A Case Series. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Fasciae of the musculoskeletal system: MRI findings in trauma, infection and neoplastic diseases. Insights Imaging 2019; 10:47. [PMID: 31001705 PMCID: PMC6473016 DOI: 10.1186/s13244-019-0735-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
The fascial system is a continuum of connective tissues present everywhere throughout the body that can be locally involved in a large variety of disorders. These disorders include traumatic disorders (Morel-Lavallée lesion, myo-aponeurotic injuries, and muscle hernia), septic diseases (necrotizing and non-necrotizing cellulitis and fasciitis), and neoplastic diseases (superficial fibromatosis, desmoid tumors, and sarcomas). The current pictorial review aims to focus on these localized disorders involving the fasciae of the musculoskeletal system and their appearance at MRI.
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Dyson K, Palan J, Mangwani J. Bilateral non-traumatic lower leg fascial defects causing peroneal muscle herniation and novel use of a GraftJacket to repair the fascial defect. J Clin Orthop Trauma 2019; 10:879-883. [PMID: 31528061 PMCID: PMC6739491 DOI: 10.1016/j.jcot.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022] Open
Abstract
Constitutional bilateral defects in the peroneal fascial compartment leading to muscle herniation are extremely rare. We present the case of a twenty-nine year old male carpenter with non-traumatic bilateral peroneal fascial defects, in which the symptomatic right side was successfully repaired using a GraftJacket®. This case report highlights the need for clinicians to remain aware of the diagnosis of muscle herniation as a cause of a painful mass in the lower limbs, especially when related to exercise. The judicious use of further imaging such as ultrasound in combination with MRI can be useful in differentiating a muscle hernia from other more sinister causes, such as malignancy.
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Affiliation(s)
- Kathryn Dyson
- Corresponding author. Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolin Road, Leicester, LE5 4PW, England, UK.
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7
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Muscle hernias of the leg: A case report and comprehensive review of the literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255031302100408] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cormier DJ, Gellhorn AC, Singh JR. Soleus Muscle Herniation With Magnetic Resonance Imaging and Ultrasound Correlation in a Female Long-Distance Runner: A Case Report. PM R 2016; 9:529-532. [PMID: 27840296 DOI: 10.1016/j.pmrj.2016.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
Abstract
This is a case of a 40-year-old female endurance athlete with right leg pain while running. A comprehensive workup revealed a fascial defect with soleus muscle herniation. Although historically in many practice settings magnetic resonance imaging is the diagnostic imaging modality of choice for suspected muscle herniation through the fascia, the use of ultrasound is increasing because of lower cost, ease of access, and dynamic evaluation. To the authors' knowledge, there has not been a direct comparison between the accuracy of magnetic resonance imaging versus ultrasound in determining the size or location of a soleus muscle herniation. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- David J Cormier
- Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY; New York-Presbyterian Hospital, New York, NY(∗)
| | - Alfred C Gellhorn
- Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY; New York-Presbyterian Hospital, New York, NY(†)
| | - Jaspal R Singh
- Division of Rehabilitation Medicine, Weill Cornell Medical College, Baker 16(th) FL, 525 E 68th Street, New York, NY 10065; New York-Presbyterian Hospital, New York, NY(‡).
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9
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Leong-Pan H, Yuen-Fai L, Archie LB, Tony CKF. A Huge Infected Popliteal Cyst Dissecting into Gastrocnemius Mimicking Calf Abscess. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2015. [DOI: 10.1016/j.jotr.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case of a chronic huge popliteal cyst, which dissected into the gastrocnemius without rupture and was complicated with acute primary infection mimicking calf abscess upon presentation. To the best of our knowledge, it is the largest popliteal cyst with intramuscular dissection reported in the literature. It is noteworthy that infected popliteal cyst is a rare differential diagnosis of calf abscess.
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Affiliation(s)
- Hung Leong-Pan
- Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital, Number 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
| | - Leung Yuen-Fai
- Department of Orthopaedics and Traumatology, Tseung Kwan O Hospital, Number 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
| | - Lo Bill Archie
- Department of Radiology, Tseung Kwan O Hospital, Number 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
| | - Chau Kwok-Fung Tony
- Department of Pathology, Tseung Kwan O Hospital, Number 2 Po Ning Lane, Hang Hau, Tseung Kwan O, Hong Kong
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Abstract
Total hip replacement (THR) is a very common procedure undertaken in up to 285 000 Americans each year. Patient satisfaction with THR is very high, with improvements in general health, quality of life, and function while at the same time very cost effective. Although the majority of patients have a high degree of satisfaction with their THR, 27% experience some discomfort, and up to 6% experience severe chronic pain. Although it can be difficult to diagnose the cause of the pain in these patients, this clinical issue should be approached systematically and thoroughly. A detailed history and clinical examination can often provide the correct diagnosis and guide the appropriate selection of investigations, which will then serve to confirm the clinical diagnosis made.
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Affiliation(s)
- B A Lanting
- London Health Sciences Center, 336 Windermere Ave, London, Ontario, Canada
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11
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US diagnosis of pediatric muscle hernias of the lower extremities. Pediatr Radiol 2013; 43 Suppl 1:S2-7. [PMID: 23478915 DOI: 10.1007/s00247-012-2347-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 10/27/2022]
Abstract
Muscle hernias result from the protrusion of muscle through acquired or congenital fascial defects. They most often occur in the lower extremities of young adults, typically men. There has been limited description in the literature of this entity in children. Our purpose is to evaluate the demographics, presentation and imaging findings of muscle hernias diagnosed by US in our pediatric patient population. We conducted a retrospective review of all lower extremity muscle hernias diagnosed by US in patients younger than 19 years of age, from January 2001 to March 2011, evaluating the reason for referral, imaging performed before and after US, and subsequent clinical course. Sixteen children were diagnosed with muscle hernia by US, 11 girls and 5 boys, ages 3 to 18 years (mean 13.8). Sixty-nine percent (n = 11) involved the tibialis anterior. Clinical suspicion for muscle hernia was present in seven patients (44%). Of the four cases where MR was performed before US, three were interpreted as normal. In 13 cases (81%), the radiologist reported that dynamic imaging with provocative maneuvers (plantar flexion, standing, squatting) was either necessary or helpful in visualizing the muscle hernia. Four children had surgery to treat symptoms. Muscle hernias are often not suspected clinically in children. US with dynamic imaging and provocative maneuvers is key to diagnosis. US confirmation of a muscle hernia provides a reassuring diagnosis and helps exclude the presence of an aggressive lesion. Surgical intervention is an option for persistent symptoms, but is often not necessary.
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12
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Kim TW, Suh JT, Son SM, Moon TY, Lee IS, Choi KU, Kim JI. Baker's Cyst with Intramuscular Extension into Vastus Medialis Muscle. Knee Surg Relat Res 2012; 24:249-53. [PMID: 23269965 PMCID: PMC3526764 DOI: 10.5792/ksrr.2012.24.4.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/06/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022] Open
Abstract
Baker's cysts are one of the most common cystic lesions around the knee joint and mainly caused by fluid distension of the gastrocnemius-semimembranous bursa that is situated along the medial side of the popliteal fossa. Typically, a Baker's cyst extends along the intermuscular planes around the knee joint and may enlarge any direction. However, it is mostly located in the inferomedial or superficial layers of the knee joint and less commonly extends laterally or proximally. Expansion of the cyst tends to respect the intermuscular planes, and Baker's cysts along the intramuscular route have been rarely reported. Thus, we report a case of Baker's cyst with intramuscular extension into the vastus medialis muscle.
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Affiliation(s)
- Tae Wan Kim
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea
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13
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[Approach to painful hip resurfacing]. DER ORTHOPADE 2011; 40:481-90. [PMID: 21614600 DOI: 10.1007/s00132-011-1757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hip resurfacing in young patients has been increasingly performed within the last decade. In comparison to standard total hip arthroplasty the failure rate remains high. Age and implant size have a significant effect on the risk of revision for primary total resurfacing and the risk of revision increases with increasing age. At 7 years the cumulative revision rate for patients is 5% and females have more than twice the cumulative revision rate as males. Even in hip resurfacing arthroplasty which has been performed in a perfect manner, a certain percentage of patients suffer from persistent pain for various reasons, such as neck fracture, iliopsoas tendinopathy, metal hypersensitivity, such as aseptic lymphocytic vasculitis associated lesions (ALVAL) and aseptic loosening. Diagnostic work-up of the painful hip resurfacing is challenging even for experienced surgeons. Recommendations for the diagnostic procedure are described.
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14
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Affiliation(s)
- Scott Tyson
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Nicklas BJ, McEneaney PA, Lichniak JE, Baron RL, Brownell BA. Surgical repair of abductor hallucis muscle herniation: a case report. J Foot Ankle Surg 2010; 49:488.e5-9. [PMID: 20797590 DOI: 10.1053/j.jfas.2010.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 06/27/2010] [Indexed: 02/03/2023]
Abstract
Herniation of the abductor hallucis muscle has rarely been reported in the literature. This condition causes localized pain, especially while weight bearing, as a result of a complex cascade of biomechanical events directly related to loss of integrity of the medial wall of the foot. The authors present a case of a flexor retinaculum tear with subsequent herniation of the abductor hallucis muscle. When conservative treatment options failed to provide significant relief, surgical intervention was performed, which revealed ischemic muscle tissue and a partial flexor retinaculum tear. The nonviable muscle was surgically debrided and the fascial defect was repaired with a polypropylene nonabsorbable synthetic surgical mesh. This herniorrhaphy reestablished medial compartment support, thus allowing the patient to return to pain-free ambulation.
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Affiliation(s)
- Bonnie J Nicklas
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA, USA
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Gokhale S. Three-dimensional sonography of muscle hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:239-42. [PMID: 17255187 DOI: 10.7863/jum.2007.26.2.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Muscle hernias through a defect in the fascia can be subtle and difficult to see on 2-dimensional (2D) scans. We describe the appearance of muscle hernias on 3-dimensional (3D) sonographic multiplanar scans and 3D rendering. METHODS Two patients were examined with a 2D linear 5- to 12-MHz probe. The questionable area was scanned with a 5- to 12-MHz linear 3D transducer. Multiplanar reconstruction and 3D rendering were performed to show the hernia. RESULTS In both cases, the muscle hernia was small and subtle on 2D scans but became slightly more prominent on examination after the muscle was exercised. In both patients, the hernias were very obvious on 3D scans. CONCLUSIONS Symptomatic muscle hernias may sometimes be very small and difficult to see on 2D scans. Three-dimensional rendering shows the hernia very well.
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Abstract
Hamstring injuries can be classified with regard to the site of involvement. Traumatic disorders at the proximal bone-tendon origin are best defined as avulsion injuries, such as ischial tuberosity fractures and hamstring tendon tears. Musculotendinous lesions include muscle strains and muscle contusions. Most hamstring injuries occur after in-direct trauma from excessive stretching or forceful contraction, leading to avulsion injuries or muscle strains and tears. Insufficient warm-up, lack of flexibility, inadequate muscle strength and endurance, or abnormal contraction and running may predispose to such injuries. In the event of blunt direct trauma, a muscle contusion, intramuscular hematoma, myositis ossificans, or compartment syndrome may develop.
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Affiliation(s)
- Jenny T Bencardino
- Medical Arts Radiology Group, PC, and Department of Radiology, Huntington Hospital, North Shore Long Island Jewish Health System, Huntington, NY 11743, USA.
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Fang CSJ, McCarthy CL, McNally EG. Intramuscular dissection of Baker's cysts: report on three cases. Skeletal Radiol 2004; 33:367-71. [PMID: 15007568 DOI: 10.1007/s00256-004-0756-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 12/31/2003] [Indexed: 02/02/2023]
Abstract
Baker's cysts are fluid distensions of the gastrocnemius-semimembranosus bursa and are the most common cystic lesion around the knee. Typically cysts enlarge along intermuscular planes around the knee. We report three cases in which the expanding cyst did not respect these planes and dissected along an intramuscular route as confirmed by MR imaging. Such behaviour by Baker's cysts is hitherto unreported in the literature. Possible mechanisms to account for this phenomenon are discussed.
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Abstract
Total hip replacement is one of the most common and successful orthopaedic procedures. However, evaluation and treatment of the painful total hip replacement is one of the most difficult challenges for the arthroplasty surgeon. The differential diagnosis includes causes that are intrinsic and extrinsic to the hip. A thorough history and physical examination provide the basis for a focused, efficient workup of the painful total hip replacement. The temporal onset, duration, severity, site, and character of the pain all provide important clues in determining the cause of the painful total hip replacement. The physical examination should focus on tests and maneuvers that reproduce the patient's symptoms. Laboratory tests and radiographic evaluation are used selectively as indicated by the history and physical examination findings. With a careful and thorough evaluation, the cause of the painful total hip replacement can be determined in most patients, and the appropriate treatment can be initiated.
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Affiliation(s)
- Kevin J Bozic
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA.
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Affiliation(s)
- Ian Beggs
- Department of Radiology, Royal Infirmary, Edinburgh EH3 9YW, Scotland, United Kingdom
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22
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Farber JM, Buckwalter KA. MR imaging in nonneoplastic muscle disorders of the lower extremity. Radiol Clin North Am 2002; 40:1013-31. [PMID: 12462466 DOI: 10.1016/s0033-8389(02)00049-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The exquisite tissue contrast and multiplanar capability of MRI make it the optimal imaging modality for diagnosing muscle injuries and other muscle disorders. These examinations can be performed with increasing speed because of improvements in gradient strength and software and coil design. Presently, some of the limitations of MRI of muscle relate to the lack of specificity of the findings. The advent of functional muscle MR[ will increase the understanding of human muscle diseases, and increasingly place MRI in a central role for diagnosis and follow-up analysis.
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Affiliation(s)
- Joshua M Farber
- Department of Radiology, Indiana University School of Medicine, University Hospital, 550 North University Boulevard, Room 0615, Indianapolis, IN 46202-5253, USA.
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Robbins GM, Masri BA, Garbuz DS, Duncan CP. Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty components. J Am Acad Orthop Surg 2002; 10:86-94. [PMID: 11929203 DOI: 10.5435/00124635-200203000-00004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The cause of pain in a patient with an apparently solidly fixed total hip arthroplasty can be difficult to elucidate. A detailed history, careful examination, and plain radiographs provide the most useful information, especially in excluding causes not primarily related to the hip. Determining whether the pain is related to the implant, to soft tissue, or to bone can require laboratory tests, radiographic and fluoroscopic imaging, and contrast arthrography and local anesthetic injections. Particularly when pain is caused by occult infection, erythrocyte sedimentation rate, C-reactive protein level, hip aspiration, advanced radiologic imaging, and nuclear medicine scans can help determine the diagnosis.
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Affiliation(s)
- Graham M Robbins
- Division of Reconstructive Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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Abstract
Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.
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