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General Rehabilitation

Traumatic Neuromas and Gastrocnemius Muscle Herniation Following Fasciotomy for Chronic Exertional Compartment Syndrome

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Ryan Floresca, MD

    Resident
    University of Texas Southwestern Medical School PM&R Program
    Dallas, Texas

    • Co-Author(s)

  • Haibi Cai, MD

    Assistant Professor
    University of Texas Southwestern Medical Center
    Seattle, Washington

Disclosure(s):
Ryan Floresca, MD: No financial relationships to disclose
Case Diagnosis: Traumatic Neuromas and Gastrocnemius Muscle Herniation Following Fasciotomy for Chronic Exertional Compartment Syndrome

Case Description or Program Description: 34-year-old female presented with pain and numbness to her left lower extremity. The patient had a diagnosis chronic exertional compartment syndrome in the left leg and over a period of 15 years, she underwent multiple compartment releases and peroneal nerve decompressions. However, immediately after her lateral and medial compartment fasciotomies 3 years ago, the patient noticed burning pain along her medial and lateral left lower leg.

Setting: Outpatient PM&R clinic

Assessment/Results: Nerve conduction and electromyography (NCS/EMG) of the left lower extremity showed absent responses in the left saphenous and left superficial peroneal sensory nerves. Left sural and common peroneal motor nerve studies were normal. Needle of the left vastus medialis, tibialis anterior, peroneus longus, and medial gastrocnemius were all normal.
Neuromuscular ultrasound of the left superficial peroneal sensory nerve at 9cm proximal to the lateral malleolus showed an end stump neuroma. Ultrasound of the left saphenous nerve at ~16 cm proximal of the medial malleolus showed focal enlargement of the nerve with an additional hypoechoic area along the fascial layer between the gastrocnemius muscle and subcutaneous tissue.
Ultrasound-guided hydro dissection with corticosteroid and lidocaine of the left superficial peroneal and left saphenous nerves were performed. Symptoms only relieved over the left superficial peroneal distribution but no improvement over left saphenous distribution. Hernia repair and saphenous neuroma resection completely resolved resolved the patient's symptoms over left saphenous distribution.

Discussion (relevance): Neuromas should be considered in cases where new neuropathic pain occurs after surgery.

Conclusions: This case highlights the importance of utilizing neuromuscular ultrasound in combination with NCS/EMG to comprehensively evaluate a patient presenting with pain and paresthesia. Ultrasound can additionally identify the presence of neuromas, accurately determine the location, guide hydrodissection, and evaluate for additional structural abnormalities such as muscle hernia