Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature

Al-Himdani, Sarah; Talbot, Christopher; Kurdy, Nasser; Pillai, Anand

doi:10.1016/j.foot.2013.08.002

Cited by 15 publications

(41 citation statements)

References 23 publications

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“…Numerous injuries to the posterior compartment can mimic gastrocnemius strain and should be included in the differential diagnosis, including Achilles tendon rupture, popliteal artery entrapment, soleus syndrome, acute compartment syndrome, chronic exertional compartment syndrome, plantaris injury, and injuries to the structures of the deep compartment (tibialis posterior, flexor digitorum longus, and flexor hallicus longus). There have been documented cases of a symptomatic flexor hallicus longus, 1 a symptomatic accessory flexor digitorum longus, 1 , 3 , 14 , 23 and a symptomatic accessory soleus. 1 , 10 Deep vein thrombosis (DVT) is both a differential diagnosis and a complication of this condition, and assessment of the calf veins at the time of the scan is standard.…”

Section: Discussionmentioning

confidence: 99%

“…There have been documented cases of a symptomatic flexor hallicus longus, 1 a symptomatic accessory flexor digitorum longus, 1 , 3 , 14 , 23 and a symptomatic accessory soleus. 1 , 10 Deep vein thrombosis (DVT) is both a differential diagnosis and a complication of this condition, and assessment of the calf veins at the time of the scan is standard. 20 If there is strong suspicion for DVT based on the clinician’s sonographic findings or clinical history, a formal bilateral lower extremity ultrasound with Doppler should be considered to evaluate for DVT.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Diagnosis of Calf Injuries

2017

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Context:The medial head of the gastrocnemius is the third most commonly strained muscle in elite athletes after the biceps femoris and rectus femoris. The differential diagnosis of posterior calf injury includes musculoskeletal and nonmusculoskeletal causes. Classically, delineation of these injuries from one another relied primarily on historical features and physical examination findings. The utilization of musculoskeletal ultrasound (sonography) has augmented the diagnosis of these injuries by providing dynamic, real-time confirmation.Evidence Acquisition:A review of PubMed, OVID, and MD Consult prior to January 2016 was performed using search terms, including soleus ultrasound, gastrocnemius ultrasound, and tennis leg. The references of the pertinent articles were further reviewed for other relevant sources.Study Design:Clinical review.Level of Evidence:Level 4.Results:There have been few reviews to date of calf injuries and the use of sonography in their diagnosis. Prompt diagnosis utilizing ultrasound allows the clinician to focus management on gastrocnemius injury if present. Two-thirds of calf injuries occur at the junction of the fascia between the medial head of the gastrocnemius and the soleus. Injuries to the lateral head of the gastrocnemius occur in up to 14% of patients in some case series, but injury may occur anywhere from the proximal origin to the mid-belly to the fascial junction with the soleus. Numerous injuries to the posterior compartment can mimic gastrocnemius strain, and musculoskeletal ultrasound can aide in their diagnosis by incorporating real-time imaging into the grading of the injury and visual confirmation of physical examination findings.Conclusion:Acute injury to the posterior compartment of the lower extremity can represent a diagnostic challenge. Medial gastrocnemius strain represents the most common injury of the posterior compartment of the lower extremity. Ultrasound is a useful tool to assist the clinician in determining the specific cause of calf injury, estimate the severity of the injury, and monitor progress of healing. The vast majority of calf injuries can be diagnosed and managed without any additional imaging. Serial diagnostic ultrasound of an injured area allows for direct monitoring of tissue healing and may allow the clinician to more confidently assess response to treatment and help guide return-to-play decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound Diagnosis of Calf Injuries

2017

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“…Magnetic Resonance Maging (MRI) is the exploration of choice, but musculoskeletal ultrasonography is also very useful in identifying the muscle as a muscular mass who is replacing the normal structure of Kager's fatpad, deep to the Achilles tendon [1,4,6,7,10]. There are several reports in the literature about clinical implications of the presence of ASM and about treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…There are several reports in the literature about clinical implications of the presence of ASM and about treatment options. The usual approach is conservative, but in some cases, the necessity of fasciotomy, debulking, tendon release or excision with good results in athletes was mentioned [1,3,5,6,10]. The administration of botulinum toxin A injection in ASM (guided by palpation and electrostimulation) was proposed as an alternative treatment to muscle excision [11].…”

Section: Discussionmentioning

confidence: 99%

"Swollen Ankle" Due to the Presence of Accessory Soleus Muscle - Case Report.

Bojincă¹,

Serban²,

Bojincă³

2017

J Bone Res

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Swollen ankle might be a problem of differential diagnosis in young patients performing physical exercises. A mass on the posteromedial region of the ankle might be attributed to the presence of Accessory Soleus Muscle (ASM), the most common supernumerary muscle in the lower leg.We present the case of a young male with swelling and moderate pain on the posteromedial part of the right ankle after prolonged physical exercise. Musculoskeletal examination identified ASM. A conservative approach (symptomatic medication, physical therapy) was recommended with good results.

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“…• Prevalence: Variable; range: 6.6 to 26% 2,31,36 • Synonyms: Differ along with the distal insertion: peroneocalcaneus externum (insertion at the retrotrochlear eminence), peroneocuboideus (insertion at the cuboid), peroneal peroneus longus (insertion at the peroneus longus) 37 • Origin: Peroneus brevis or more rarely the peroneus longus or the posterior aspect of the fibula 1,31 • Insertion: Most often at the retrotrochlear eminence, more rarely at the cuboid, peroneus longus, or inferior retinaculum 31,36,37 • Potential symptoms: May simulate a retrotrochlear mass lesion clinically (►Fig. 12) or may cause local friction with the peroneus brevis and longus and predispose to instability, snapping, tenosynovitis, and longitudinal splitting of the peroneus brevis 1,31,[38][39][40][41][42] • Differential diagnosis: The peroneus quartus should be distinguished from a low-lying peroneus brevis based on the detection of a distinct distal tendon diverging from the peroneus brevis 2,31 Flexor Digitorum Accessorius Longus…”

Section: Anklementioning

confidence: 99%

Accessory Muscles of the Extremities

Vanhoenacker

Desimpel

Mespreuve

et al. 2018

Semin Musculoskelet Radiol

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Accessory muscles and variations are not uncommon at the upper and lower extremity. They are often overlooked because they are asymptomatic and present as incidental findings on imaging. However, they may present as a soft tissue swelling, thereby mimicking soft tissue tumors. Other symptoms are attributed to impingement on neurovascular structures and to exercise-related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of it are the clues to correct identification. On ultrasound, accessory muscles have a similar echotexture as other muscles, whereas the signal intensity on magnetic resonance imaging (MRI) is similar to muscle. Because of the intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best depicted on MRI without fat suppression. This article provides a short overview of the anatomy of most prevalent accessory muscles of the upper and lower limb and its potential pathogenic nature.

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Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature

Cited by 15 publications

References 23 publications

Ultrasound Diagnosis of Calf Injuries

Ultrasound Diagnosis of Calf Injuries

"Swollen Ankle" Due to the Presence of Accessory Soleus Muscle - Case Report.

Accessory Muscles of the Extremities

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