Revista de Medicina Desportiva (English) November 2018 | Page 11

Rev. Medicina Desportiva informa, 2018; 9(6):9-11.
Hard Work, Soft Swelling –
Muscular Hernia
Dr. Luís Duarte 1 , Dra. Marisa Bizarro 1 , Dra. Dora Alves 2
1
Resident of Medical General Practitioner, USF Grão Vasco; 2 Medical General Practitioner Specialist USF
Grão Vasco – Viseu, Portugal
RESUMO / ABSTRACT
The muscular hernia is defined as a protrusion of muscle tissue through a defect in the muscular
fascial sheath. Muscular hernias are often underdiagnosed or misdiagnosed. They are divided into
traumatic and constitutional, being the anterior tibial muscle the most frequently affected. A mass
that is visible only during contraction of the musculature favors the diagnosis, and this should be
confirmed by imaging. Most are asymptomatic, requiring no treatment. When they are slightly
symptomatic, resting, restriction of physical exercise and the use of compression stockings is indi-
cated. Surgery may be indicated in the highly symptomatic cases.
PALAVRAS-CHAVE / KEYWORDS
Muscular hernia, physical activity
Inroduction
A muscle hernia (MH) is defined as
protrusion of muscle tissue through a
defect of the muscle fascia sheath. 1-2
The MHs (muscle hernias) can afflict
any area in the body, but they are
more frequent in the lower limbs,
where the tibial anterior muscle is
most often affected. 1-3 Usually they
are underdiagnosed or incorrectly
diagnosed as an hematoma or a
varicose vein. The true incidence of
MH in the lower limb is unknown.
The MH are traumatic or constitu-
tional, where the constitutionals
can have a starting point from
the holes located on the muscle
compartments through which the
perforating veins penetrate. Due to
the chronic stress, the dimensions
of those holes increase allowing the
protrusion of the muscle tissue. 1 The
traumatic MHs result from direct
and indirect trauma. 1
Usually MHs appear on young
sporstman. 4 They can be seen as
a protuberance that is only visible
when standing or after muscle
contraction. 4 On rest, this protuber-
ance usually is not seen. 4 MHs can
be symptomatic or asymptomatic.
When they are symptomatic, pain
is usually the main symptom. 3 The
diagnosis is clinical based and later
supported by image exams, where
echography is the more accessible. 1-3
There is no ideal treatment for the
muscle hernias. 1-3 Treatment varies
according the symptomatology and
it can include rest, physical exercise
restriction, use of compression
stockings, surgery or just surveil-
lance. 1-3
Clinical case
This is the case about a young male,
17 years old, gym practitioner,
twice a week, one hour / day for 18
months. The gym activities fre-
quently included the elevation of
40kgs weights, with both lower limbs
at the same time. He had 3 hours of
physical education at the school and
a walking of 30 minutes daily. He
denied the regular practice of other
physical and sports activities. He
had no personal or family relevant
pathological background. He had an
appointment because of a swelling
of about 1,5 x 1,5 cm located on the
anterolateral area of the lower third
of his left leg for 8 days. He denied
pain, functional limitation and there
wasn’t any change of the color on
the leg. He denied any fall or other
trauma, just referring the already
described physical activity. On physi-
cal examination there was a swell-
ing with soft consistence, mobile,
without pulsation, measuring about
1,5 com on its longer axis on the
anterolateral area of the lower third
of his left leg. There wasn’t nor pain
on palpation, nor any change of the
skin coloration or of the local tem-
perature. The swelling was visible
with sight contraction of the left leg
muscle. At rest and without contrac-
tion the swelling was not visible.
An ultrasonography directed to
the soft tissue was ordered to clarify
the situation and a conservative
treatment was started, with surveil-
lance and eviction of weight training
for the legs. The ultrasonography
revealed a muscle hernia, with
15mm of extension and without
criteria of rupture. He had another
medical appointment 41 days after
the first visit for reevaluation. He
stated the perception of a decrease
on the size of the MH on the left leg
and denied any other symptomology.
He indicated that only once went
to the gym during that period, but
without lifting weights with the left
leg. He had participated at school
on the physical education classes
without restrictions. On physical
examination it was seen he same
dimensions of the MH, measuring
about 1,5cm on its longer axis. There
wasn’t any change on the skin color
and also with no pain on palpa-
tion. However, the MH was now only
seen after vigorous muscle contrac-
tion of the leg. Once again, he was
advised for surveillance and eviction
of weight training for the legs, but
without any restriction for other
physical activities. A reevaluation
was scheduled after 3 months.
Discussion
It seems that the study of MHs,
especially those of the lower limbs,
started on 1929 by Hugo Idhe. 1 His-
torically, the military surgeons, when
they studied the MHS on military
recruits, gave a great contribution for
the knowledge of this pathology. 2 The
true incidence of MHs on the lower
limbs is unknown, because some of
the them are asymptomatic that do
not promote the medical aid. 2,3
This clinical case shows that,
although physical exercise has
several health benefits, when exag-
gerated or deregulated can bring
disastrous consequences. 5 In the
presence of a clinical suspicion of a
Revista de Medicina Desportiva informa setembro 2018 · 9