Chronic muscle injury - ultrasound

Case contributed by Dr Maulik S Patel

Presentation

Fracture of the tibia and fibula 18 months prior. Now bulge in the proximal lateral leg precipitated by ankle movements.

Patient Data

Age: 8 years
Gender: Male

Healed fracture of mid diaphysis of tibia and fibula.

Ultrasound

Affected tibialis anterior muscle shows an area of increased echogenicity with loss of normal fibrillar echo pattern of muscle fibers. The central tendon could not be identified. Two tiny calcification foci are also seen in the tendon. The adjacent muscle is involved to a lesser extent. No muscle hernia.

Case Discussion

Findings of chronic muscle injury in case of an old healed fracture of tibia and fibula.

The 'bulge' described by the patient and inspected by the clinician was seen during the contraction of the tibialis anterior muscle. Due to the loss of normal muscle anatomy, the angle of contraction of muscle fibers along the central tendon was disturbed. That was the reason for the local bulge without any fascial defect (muscle hernia).

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