Thursday , 23 November 2017
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Muscle Pathology

Myositis Ossificans – Carles Pedret (carlespedret), Sports Medicine and Sports Orthopedics

This male football (soccer) player. Suffered a muscle contusion during a match in the lateral side of the thigh. The initial diagnosis was a vastus medialis muscle rupture with a hematoma. After 3 weeks he came to our medical services with a painful, tender, enlarging mass, located in the lateral side of the thigh (where the first injury was). In the ultrasound examination we found a heterotopic calcification inside the vastus medialis muscle which was a myositis ossificans. We also made a CT scan to complete the diagnosis. CT images are similar to those of plain radiography, demonstrating mineralisation proceeding …

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Intramuscular lipoma – Suresh Sudula (@SureshSudula) , MSK Consultant Physiotherapist

This 54 year old lady presented with a one year history of a soft tissue lump over the ulna aspect of the right hand. She reported that the lump had been getting slightly bigger over the last few weeks and it was not painful. A diagnostic MSK ultrasound scan of her right hand in the clinic today showed an ill-defined mixed echogenic inhomogeneous soft tissue mass noted over the hypo thenar eminence of the right hand extending to the ulna border.  The soft tissue mass measured 3.2 x 1.5cm in diameter. There is no vascularity noted on power doppler.  Appearances …

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Exertional tibialis anterior muscle hernia – Suresh Sudula, MSK Consultant

This interesting case demonstrates the benefit of linking  musculoskeletal ultrasound with a clinical examination. This football player had been referred to the ultrasound department with a three year history of a lump which appeared intermittently over the lateral aspect of her leg. She had been seen by an Orthopaedic physician and had an ultrasound scan without conclusive findings or diagnosis.  She was also referred to an Orthopaedic surgeon who requested an MRI scan which was reported as normal. The MRI Images can be seen here... When I saw the patient in clinic I asked her what provokes the lump in …

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Morel-Lavallée lesion- Suresh Sudula, MSK Consultant Physiotherapist

Figure 4: Longitudinal view of Morell Lavallee lesion

This gentleman in his early 30's, had been referred with a nine week history of swelling over the lateral aspect of the left thigh.  He recalled being hit with a metal bar, and the swelling developing since. The patient reported the swelling had gone down  slightly but there was still a visible swelling present over the lateral aspect. He did not report any paraesthesia. On examination, there was a visible swelling over lateral aspect of the left thigh. There was no evidence of bruising. There was full range of movement of the knee and hip. There was no tenderness on …

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Fat rupture mimicking a muscle tear – Suresh Sudula, Consultant MSK Physiotherapist

Transverse view of fat rupture of thigh

This case provides some food for thought when assessing patients who have palpable steps in their soft tissues following direct trauma. This patient in his late 20's had fallen off his bike six weeks earlier, but had continued to complain of a swelling over the lateral aspect of his thigh. The area which impacted the ground when he fell. Although he did report that this had improved steadily over the past six weeks. He was subsequently referred to the Radiology department for an ultrasound of the area. As this patient was seen within Radiology, there was not time for a full …

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Tear of the musculotendinous junction of an achilles tendon

Well delineated hypo-echogenic area in the musculotendinous junction of the Achilles tendon and early emergence of soleus muscle on musculoskeletal ultrasound

Thanks to Rob Mast, Extended Scope Physiotherapist for this interesting case... This patient was a 30 year old male. He ran up the steps at a tube station and felt a sudden pulling sensation in the lower calf.  He then struggled to walk for several days, with a sharp pain and tightness. Two days following the injury there was a well delineated hypo-echogenic area in the musculotendinous junction of the  Achilles tendon and early emergence of soleus muscle on musculoskeletal ultrasound (Figure 1). This finding was discussed with two experienced musculoskeletal ultrasound specialists.  As this was such a well defined …

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