Calf pseudohipertrophy.

Area of Science:

• Neurology
• Musculoskeletal Medicine

Background:

• Calf pseudohypertrophy is an uncommon clinical presentation.
• Radiculopathy, or nerve root compression, is a known cause of muscle weakness.
• The combination of these two is exceptionally rare.

Observation:

• A 67-year-old woman presented with a year-long history of painless right calf enlargement and progressive loss of strength.
• The patient had a prior history of lumbar disc surgery.
• Clinical examination revealed significant calf hypertrophy and reduced muscle strength.

Findings:

• Electromyography confirmed chronic S1 radiculopathy.
• Radiological imaging demonstrated adipose tissue substitution of normal muscle in the medial gastrocnemius and soleus muscles of the right leg.
• No evidence of primary myopathy or sarcomatous degeneration was found.

Implications:

• This case highlights that calf pseudohypertrophy can be an unusual manifestation of chronic radiculopathy.
• It underscores the importance of considering neurological causes for unexplained muscle enlargement and weakness.
• Accurate diagnosis requires a combination of clinical assessment, electrodiagnostic studies, and imaging to differentiate from other pathologies.