Disclosures: Denesh Ratnasingam, MD: No financial relationships or conflicts of interest

Case Diagnosis: Tibialis Anterior Herniation

Case Description: A 21-year-old female presented with a two-week onset of right anterior shin swelling associated with running and placing pressure on the leg and alleviated with rest. She rated pain as 4/10 on the visual analog scale and denied any injury, inciting event, nor any numbness, tingling, or radiation of symptoms. Swelling and pain were affecting her marathon training and limiting her distance. She had mild tenderness to palpation over area of swelling in anterior shin, full range of motion of the knee and ankle. She had 5/5 manual muscle strength in bilateral lower extremities, and ambulated on her heels and toes without any difficulty; however, when attempting a Fencer’s lunge with left leg, swelling and pain increased.

Setting: Sports Medicine ClinicAssessment/

Results: Exam under dynamic ultrasound revealed a strain of muscle at the lower right leg level with possible fascial defect causing muscle herniation not present on the left. X-ray of the right tibia and fibula revealed no cortical irregularities nor fracture. The patient’s symptoms and exam were consistent with muscle herniation of the tibialis anterior.

Discussion: Tibialis Anterior Herniation is a rare myofascial defect associated with congenital weakness, penetrating trauma, closed fracture and fascial tear from excessive muscular force. Fascial defects secondary to increased intercompartmental pressures are hypothesized as a leading cause in athletes without any inciting trauma. The Fencer’s lunge position aggravates pain and increases size of swelling is commonly associated with this diagnosis. Treatment varies from rest to reduced exercise to surgical management – though recurrence of herniation has been documented.

Conclusion: Tibialis Anterior Herniation is a rare presentation of myofascial defect. As a physiatrist, focused physical exam and dynamic ultrasonography can aid in appropriate diagnosis and reduce further testing and assist athletes with a plan for rehabilitation. The case patient was recommended a compression sleeve and relative rest.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-interesting-presentation-of-tibialis-anterior-herniation-affecting-marathon-training-a-case-report/