Complications of vertebral diseaseFocal Myositis of the Calf following S1 Radiculopathy
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)
- et al.
Dominant inherited distal spinal muscular atrophy with atrophic and hypertrophic calves
J Neurol Sci
(1993) - et al.
Congenital monomelic neurogenic disorder with calf muscle hypertrophy
Brain Dev
(2003) - et al.
Pain and calf hypertrophy associated with spontaneous repetitive discharges treated with botulinum toxin
Clin Neurophysiol
(2005) - et al.
Muscle hypertrophy with complex repetitive discharges in C-6 radiculopathy
Clin Neurol Neurosurg
(2005) - et al.
S-1 radiculopathy as a possible predisposing factor in focal myositis with unilateral hypertrophy of the calf muscles
J Neurol Sci
(1999) - et al.
A swollen calf
Lancet
(2005) - et al.
Focal myositis: a clinicopathological study
Neuromuscul Disord
(1995) - et al.
Focal myositis
Cancer
(1977) - et al.
Denervating changes in focal myositis, a benign inflammatory pseudotumor
Arch Pathol Lab Med
(1980) - et al.
Calf enlargementS1 radiculopathy, and focal myositis
Muscle Nerve
(1992)
[True muscular hypertrophy secondary to peripheral nerve disorder. Clinical and histological study in a case of calf hypertrophy induced by sciatica]
Rev Neurol (Paris)
Muscle hypertrophy after partial denervation: a human case
J Neurol Neurosurg Psychiatry
Unilateral calf enlargement following S1 radiculopathy
Muscle Nerve
Muscular hypertrophy after chronic radiculopathy
Arch Neurol
Isolated muscle hypertrophy as a sign of radicular or peripheral nerve injury
J Neurol Neurosurg Psychiatry
Neurogenic muscle hypertrophy in radiculopathy
Acta Neurol Scand
[Neurogenic muscle hypertrophy: 3 cases]
Rev Neurol
Unilateral calf hypertrophy seen in lumbosacral stenosis
Spine
Unilateral calf hypertrophy
J Neurol Neurosurg Psychiatry
Hypertrophy of the calf with S-1 radiculopathy
Arch Neurol
[A case of sciatica with hypertrophy of the calf]
Rev Neurol (Paris)
Neurogenic muscle hypertrophyReport of two cases
J Neurol
Selective type II muscle fiber hypertrophy in severe infantile spinal muscular atrophy
J Child Neurol
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2022, Revue du Rhumatisme MonographiesFocal myositis: An unknown disease
2017, Revue de Medecine InterneCalf pseudohipertrophy
2017, Reumatologia ClinicaFocal myositis: A review
2016, Neuromuscular DisordersCitation Excerpt :Therefore Gaeta et al. proposed a classification depending on the extent of muscle involvement: classes 1, 2 and 3 refer to FM involving a part of muscle, a whole muscle, and adjacent muscles respectively [5]. The mass is dense and firm, of variable size, and reported as painful in 14%–75% of patients [1,4,8,11]. In the largest series of 115 FM cases documented by muscle biopsy, the mean size was 3 cm, ranging from 1 to 20 cm, and pain was reported in 31 patients [27%] [4].
Focal myositis - A neurogenic phenomenon?
2012, Neuromuscular DisordersCitation Excerpt :Occasionally, however, neurogenic lesions can result in a paradoxical muscle enlargement and rarely, hypertrophy [3]. In previously published cases of denervation muscle hypertrophy, the majority were confined to the calf muscle and involvement of the S1 nerve root [4–6]. In addition, most reports describing denervation hypertrophy are based on one or two cases [7–9].
The authors have no conflicts of interest to disclose.