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Musculoskeletal and Sports Medicine

Ultrasound-Guided Fasciotomy for the Treatment of a Traumatic Leg Anterior Compartment Muscle Hernia: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Case Report Theater

    Primary Author(s)

  • Cam Smock, MD

    Resident Physician
    Mayo Clinic College of Medicine & Science (Rochester) PM&R Program
    Rochester, Minnesota

    • Co-Author(s)

  • Jacob Sellon, MD

    Co-Chair, Sports Medicine Division
    Mayo Clinic Rochester
    Rochester, Minnesota

Disclosure(s):
Cam Smock, MD: No financial relationships to disclose
Jacob Sellon, MD: No financial relationships to disclose
Case Diagnosis: Post-traumatic right leg anterior compartment muscle hernia

Case Description or Program Description: A 53-year-old male presented with a painful anterolateral leg mass that had been present since a traumatic laceration of his right lower leg 7 months prior. Focal anterior lower leg swelling and severe pain persisted despite several months of activity modification, physical therapy, and compressive wrapping.

Setting: Sports Medicine Clinic

Assessment/Results: Examination demonstrated an anterolateral leg mass, which was tender to palpation and increased in size with active dorsiflexion. Magnetic resonance imaging (MRI) and diagnostic ultrasound confirmed a 5.5-centimeter by 1.5-centimeter anterior compartment fascial defect with associated muscle hernia involving the anterior tibialis and extensor digitorum longus muscles. The patient declined open surgical treatment options, opting to pursue ultrasound-guided fasciotomy.

The procedure was performed in clinic under local anesthesia. Neurovascular structures were identified to ensure sufficient distance from the planned fasciotomy path. A small incision was made to introduce a meniscotome to the anterior compartment fascia. Continuous sonographic guidance was used to cut 20 centimeters of the anterior compartment fascia, through the fascial defect to the planned distal site. The patient tolerated the procedure well without complication. The incision was closed with topical skin adhesive and thin bandages.

Discussion (relevance): Surgical fasciotomies are a common treatment option for symptomatic muscle hernias refractory to conservative care. Ultrasound-guided fasciotomies have previously been utilized for the treatment of chronic exertional compartment syndrome (CECS). This procedure can be performed under local anesthesia with a tiny incision and minimal post-procedure restrictions.

Conclusions: This case describes the novel use of an ultrasound-guided fasciotomy for the treatment of a symptomatic anterior compartment muscle hernia. The technique described here has previously been used to successfully treat CECS. Further evaluation is warranted to assess the efficacy of this procedure for the treatment of symptomatic muscle hernias.