Complications of vertebral disease
Focal Myositis of the Calf following S1 Radiculopathy

https://doi.org/10.1016/j.semarthrit.2007.09.004Get rights and content

Objectives

To determine the clinical, pathological, and magnetic resonance imaging (MRI) characteristics and outcome of focal myositis of the calf associated with S1 radiculopathy.

Methods

Case report and systematic review of literature using a literature review based on a Medline search from 1950 to 2006. Only cases with myositis documented on muscle biopsy examination were included.

Results

Six patients, including ours, with focal myositis of the calf associated with chronic S1 radiculopathy have been reported. Creatine phosphokinase levels were high in 5 cases. MRI provided evidence of global hypertrophy and inflammatory signals affecting the whole of 1 or several muscle heads of the triceps. Electromyography confirmed the existence of neurogenic abnormalities with nearly constant spontaneous activity. Histological analysis of muscle tissue showed an inflammatory infiltrate and denervation lesions. Progression was slow and corticosteroid treatment had little effect. There was no extension toward a diffuse form.

Conclusions

Hypertrophy in a denervated muscle should lead the physician to consider a diagnosis of localized secondary myositis. On the other hand, localized hypertrophic myositis is suggestive of previous radicular distress in the territory concerned. The identification of this condition in focal myositis makes it possible to avoid unnecessary additional investigations and escalation of treatment.

Section snippets

Methods

We present a case of myositis of the calf following chronic S1 radiculopathy and a review of published studies on this type of focal myositis.

Published cases of focal myositis with peripheral nervous system involvement were identified by a computerized Medline search of articles published from 1950 to 2006. The key words used were myositis, inflammatory myopathy, muscular hypertrophy, denervation, sciatica, radiculopathy, and nerve lesion. Only publications in English or French were selected

Case Report

A 40-year-old man consulted in February 2005 for painful hypertrophy of the left calf.

In November 2000, this patient presented acute lumbago followed by S1 left sciatica. A computed tomographic (CT) scan of the lumbar spine showed a L5-S1 disc hernia. From December 2000 onwards, only mild S1 radicular pain persisted but the patient reported a gradual increase in the volume of the left calf, accompanied by cramps in the early morning. His condition progressed with increased pain and tenderness

Results

A literature review found 5 other reported cases of localized myositis following peripheral neurogenic problems. The clinical, laboratory, and MRI characteristics of the 6 cases are shown in Table 1. All these cases involved myositis of the calf following S1 radiculopathy (3, 39, 40, 41).

The patients included 5 men and 1 woman with a mean age of 39 (36, 37, 38, 39, 40, 41, 42, 43, 44) years. All initially suffered S1 radiculopathy due to L5-S1 disc herniation. Four of the 6 patients underwent

Discussion

Myositis secondary to chronic denervation is rare, but its frequency may be underestimated due to misidentification. In more than 15 of the 60 or so reported cases of muscular hypertrophy after denervation, the results of histological studies of muscle biopsies were not reported (10, 11, 30, 31, 32, 33, 34, 35, 36, 37, 38), and the biopsy showed no signs of myositis in more than 40 other cases (4, 5, 6, 7, 8, 9, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29). We suggest

References (47)

  • J. Laprèsle et al.

    [True muscular hypertrophy secondary to peripheral nerve disorder. Clinical and histological study in a case of calf hypertrophy induced by sciatica]

    Rev Neurol (Paris)

    (1973)
  • J.L. Bernat et al.

    Muscle hypertrophy after partial denervation: a human case

    J Neurol Neurosurg Psychiatry

    (1978)
  • U. Mielke et al.

    Unilateral calf enlargement following S1 radiculopathy

    Muscle Nerve

    (1982)
  • P. Montagna et al.

    Muscular hypertrophy after chronic radiculopathy

    Arch Neurol

    (1984)
  • H.P. Mattle et al.

    Isolated muscle hypertrophy as a sign of radicular or peripheral nerve injury

    J Neurol Neurosurg Psychiatry

    (1991)
  • W. Drozdowski et al.

    Neurogenic muscle hypertrophy in radiculopathy

    Acta Neurol Scand

    (1994)
  • D. Deffond et al.

    [Neurogenic muscle hypertrophy: 3 cases]

    Rev Neurol

    (1996)
  • K.R. Swartz et al.

    Unilateral calf hypertrophy seen in lumbosacral stenosis

    Spine

    (2002)
  • A. Coles et al.

    Unilateral calf hypertrophy

    J Neurol Neurosurg Psychiatry

    (2004)
  • K. Ricker et al.

    Hypertrophy of the calf with S-1 radiculopathy

    Arch Neurol

    (1988)
  • G. Serratrice et al.

    [A case of sciatica with hypertrophy of the calf]

    Rev Neurol (Paris)

    (1989)
  • D. Pareyson et al.

    Neurogenic muscle hypertrophyReport of two cases

    J Neurol

    (1989)
  • D.W. Kingura et al.

    Selective type II muscle fiber hypertrophy in severe infantile spinal muscular atrophy

    J Child Neurol

    (1991)
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    The authors have no conflicts of interest to disclose.

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