Clinical findings:
(1) radiating neurogenic pain if there is compression of the superficial peroneal or other nerve by herniating muscle
(2) acute pain may occur with:
(2a) an acute fascial tear (tends to be localized)
(2b) ischemia of herniated muscle
(2c) acute compartment syndrome (affects a larger area)
(3) local tenderness may be present over the fascial defect
(4) chronic exertional pain may indicate a compartment syndrome
Imaging studies will show:
(1) fascial defect
(2) herniation of muscle through the defect
If muscle herniation is present then compartment pressures should be measured to exclude a compartment syndrome.
Management:
(1) No therapy is required for a painless muscle herniation.
(2) Fasciotomy is performed on a patient with intractable pain and/or severe compartment syndrome.
(3) No attempt is made at closure of the defect since this can precipitate an acute compartment syndrome.
