Treatment of a symptomatic forearm muscle herniation with a wrap-around fascia lata graft

Abstract

Muscle herniation in the extremity is a well-recognized cause of symptomatic pain on exertion. Only 17 cases involving the upper limb has been previously described, 11 of them involving the anterior compartment of the forearm and only 2 were caused by strenuous exertion. Treatment for this condition ranged from nonsurgical, primary closure with palmaris longus interweave, formal fasciotomy, to closure with a tensor fascia lata graft.

This is a study of a 28-year-old man who had a symptomatic swelling on the volar aspect of his left forearm while working on a car-door assembly line that resulted in a significant decreased of his grip strength, work capacity and median nerve symptoms. It did not improve after 6 months of conservative management including hand therapy and splintage. The patient subsequently underwent a tensor fascia lata graft wrap-around. Postoperatively his symptoms resolved with improvement in his grip strength and hand function. The rationale for the treatment option chosen is discussed.

Keywords

Muscle hernia - Ocoele - Forearm - Fascia lata graft

• References

• 1 Roberts JO, Regan PJ, Dickinson JC, Bailey BN. Forearm muscle herniae and their treatment. J Hand Surg [Br] 1989; 14: 319-321
• 2 Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin North Am 2002; 40: 333-362
• 3 Schechter DC, Waddell WR, Coppinger WR. Muscle hernia: Twenty personal observations. Am Surg 1963; 29: 483-490
• 4 Olch CL, Watson HK. Symptomatic forearm fascial hernia. J Hand Surg [Am] 1996; 21: 693-695
• 5 Kendi TK, Altinok D, Erdal HH, Kara S, Kendi TK, Altinok D, Erdal HH, Kara S. Imaging in the diagnosis of symptomatic forearm muscle herniation. Skeletal Radiol 2003; 32: 364-366
• 6 Riordan C, Hussain M, McCann J. Forearm muscle hernia: a case report. Eur J Plast Surg 2002; 25: 231-232
• 7 Golshani SD, Lee C, Sydorak R. Symptomatic forearm muscle hernia: repair by autologous fascia lata inlay. Ann Plast Surg 1999; 43: 204-206
• 8 Simon HE. Muscle hernia: with report of six additional cases in the arm and leg. Mil Surg 1945; 97: 369-374