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Muscle herniae in exercise-induced leg pain: diagnostic pitfalls and the 'repair paradox'
Corrado Antonetti1, Nat Padhiar2, Otto Chan3
1Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, Italy.
Background:
Muscle herniae are an uncommon distinct clinical entity within the broad spectrum of exercise-induced leg pain (EILP). Given the symptomatic overlap with other prevalent conditions and physicians' lack of familiarity, muscle herniae are frequently misdiagnosed, leading to ineffective therapeutic strategies.
Sources Of Data:
We conducted a comprehensive review of the literature to analyze the pathophysiological mechanisms, diagnostic pitfalls, and therapeutic paradigms associated with muscle herniation in athletes.
Areas Of Agreement:
Standard static magnetic resonance imaging yields a high rate of false negatives. Dynamic ultrasonography is the diagnostic gold standard, allowing for real-time visualization of the fascial defect under load.
Areas Of Controversy:
A 'surgical paradox' exists regarding surgical management: direct repair (closure) of the fascial defect increases intracompartmental pressure and risks to precipitate acute compartment syndrome, whereas surgeons historically debated the morbidity of open decompression.
Growing Points:
Decompression fasciotomy, especially minimally invasive fasciotomy, have emerged as the safest and most effective solution for symptomatic patients, prioritizing functional decompression over anatomical restoration.
Areas Timely For Developing Research:
Current guidelines rely predominantly on Level IV-V evidence. Future prospective comparative studies are needed to further standardize surgical indications and long-term outcomes.
