Clinical and morphological study of calf enlargement following S-1 radiculopathy

Nascimento, Osvaldo J. M.; Freitas, Marcos R. G. de; Hahn, Myrian D.; Araújo, Abelardo Q. C.

doi:10.1590/S0004-282X1992000300021

Abstracts

Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L5-S1 disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

Muscle hypertrophy; calf enlargement; radiculopathy; muscular biopsy; electron microscopy

A hipertrofia da panturrilha no curso de ciática é raramente observada. É relatado o caso de uma paciente com 28 anos de idade que apresentou episódios repetidos de dor lombar irradiada para nádega e pé esquerdos. Um ano após o início dos sintomas, notou aumento da panturrilha esquerda. Estudos radiográficos revelaram degeneração do disco de L5-S1 . O exame eletromiográfico mostrou desnervação muscular com velocidade de condução motora normal. Foram realizadas biópsias dos músculos gastrocnêmios. No esquerdo notou-se hipertrofia das fibras tipo 2, em comparação ao gastrocnêmio direito. A microscopia eletrônica revelou aumento do número de mitocôndrias nas fibras hipertrofiadas. Explicação satisfatória para a hipertrofia muscular na vigência de desnervação ainda não foi definida.

hipertrofia muscular; aumento da panturrilha; radiculopatia; microscopia eletrônica

Osvaldo J. M. Nascimento^I; Marcos R. G. de Freitas^I; Myrian D. Hahn^II; Abelardo Q. C. Araújo^I

^IDepartments of «Clinical Medicine (Neurology)

^IIPathology (Neuropathology), Hospital Universitário Antonio Pedro, Universidade Federal Fluminense (UFF)

SUMMARY

Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L₅-S₁ disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

Key words: Muscle hypertrophy, calf enlargement, radiculopathy, muscular biopsy, electron microscopy.

RESUMO

A hipertrofia da panturrilha no curso de ciática é raramente observada. É relatado o caso de uma paciente com 28 anos de idade que apresentou episódios repetidos de dor lombar irradiada para nádega e pé esquerdos. Um ano após o início dos sintomas, notou aumento da panturrilha esquerda. Estudos radiográficos revelaram degeneração do disco de L₅-S₁ . O exame eletromiográfico mostrou desnervação muscular com velocidade de condução motora normal. Foram realizadas biópsias dos músculos gastrocnêmios. No esquerdo notou-se hipertrofia das fibras tipo 2, em comparação ao gastrocnêmio direito. A microscopia eletrônica revelou aumento do número de mitocôndrias nas fibras hipertrofiadas. Explicação satisfatória para a hipertrofia muscular na vigência de desnervação ainda não foi definida.

Palavras-chave: hipertrofia muscular, aumento da panturrilha, radiculopatia, microscopia eletrônica.

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Dr. Osvaldo J. M. Nascimento Rua Mal. Ramon Costilla 251/903 - 22290 Rio de Janeiro RJ -Brasil.

1. Bernat JL, Ochoa JL. Muscle hypertrophy after partial denervation: a human case. J Neurol Neurosurg Psychiatry 1978, 41:719-725.
2. Bertorini TE, Igarashi M. Post poliomyelitis muscle pseudohypertrophy. Muscle Nerve 1985, 8:644-649.
3. Bouwsna G, Van Wijngaarden GK. Spinal muscular atrophy and hypertrophy of the calves. J Neurol Sci 1980, 44:275-279.
4. De Visser M, Hoogendijk JE, De Visser BWO, Verbeeten BJ. Calf enlargement in hereditary motor and sensory neuropathy. Muscle Nerve 1990, 13:40-46.
5. Korczyn AD, Kuritzky A, Sandbank U. Muscle hypertrophy with neuropathy. J Neurol Sci 1978, 36 :399-408.
6. Lapresle J, Fardeau M, Said G. L'hypertrophie musculaire vraie secondaire à une atteinte nerveuse périphérique: étude clinique et histologique d'une observation d'hypertrophie du mollet consécutive à une sciatique. Rev Neurol (Paris) 1973, 128 :153-160.
7. Lhermitte J. Hypertrophie des muscles de la jambe consécutive à une lésion du nerf sciatique par balle. Rev Neurol (Paris) 1918, 33:56-58.
8. Lhermitte J, Albessard M. L'hypertrophie musculaire de l'a jambe dans la névrite sciatique. Rev Neurol (Paris) 1932, 83:78-90.
9. Mattle HP, Hess CW, Ludin H-P, Mumenthaler M. Isolated muscle hypertrophy as a sign of radicular or peripheral nerve injury. J Neurol Neurosurg Psychiatry 1991, 54:325-329.
10. Mielke U, Ricker K, Emser W, Boxler K. Unilateral calf enlargement following S__l radiculopathy. Muscle Nerve 1982, 5:434-438.
11. Montagna P, Martinelli P, Rasi F, Cirignotta F, Govoni E, Lugaresi E. Muscular hypertrophy after chronic radiculopathy. Arch Neurol 1984, 41 :397-398.
12. Pearn JH, Hudgson P. Anterior-horn cell degeneration and gross calf hypertrophy with adolescent onset. Lancet 1978, 1:1059-1061.
13. Ricker K, Rohkamm R, Moxley RT. Hypertrophy of the calf with S₁ radiculopathy. Arch Neurol 1988, 45:660-664.
14. Serratrice G, Pellissier JF, Marini JF, Valentin-Leccese P. Un cas de sciatique avec hypertrophie du mollet. Rev Neurol (Paris) 1989, 145:474-477.
15. Valenstein E, Watson RT, Parker JL. Myokymia, muscle hypertrophy and percussion myotonia in chronic recurrent polyneuropathy. Neurology 1978, 28:1130-1134.
16. Yamada M, Kano M, Chida K, Furukawa T, Tsukagoshi H. A symptomatic benign familial spinal muscular atrophy with hypertrophy of the calves and high creatine kinase levels. J Neurol Neurosurg Psychiatry 1988, 51:452-453.

Clinical and morphological study of calf enlargement following S-1 radiculopathy

Estudo clínico e morfológico da hipertrofia de panturrilha no curso de radiculopatia S₁

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Sept 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bernat JL, Ochoa JL. Muscle hypertrophy after partial denervation: a human case. J Neurol Neurosurg Psychiatry 1978, 41:719-725.

[2] 2. Bertorini TE, Igarashi M. Post poliomyelitis muscle pseudohypertrophy. Muscle Nerve 1985, 8:644-649.

[3] 3. Bouwsna G, Van Wijngaarden GK. Spinal muscular atrophy and hypertrophy of the calves. J Neurol Sci 1980, 44:275-279.

[4] 4. De Visser M, Hoogendijk JE, De Visser BWO, Verbeeten BJ. Calf enlargement in hereditary motor and sensory neuropathy. Muscle Nerve 1990, 13:40-46.

[5] 5. Korczyn AD, Kuritzky A, Sandbank U. Muscle hypertrophy with neuropathy. J Neurol Sci 1978, 36 :399-408.

[6] 6. Lapresle J, Fardeau M, Said G. L'hypertrophie musculaire vraie secondaire à une atteinte nerveuse périphérique: étude clinique et histologique d'une observation d'hypertrophie du mollet consécutive à une sciatique. Rev Neurol (Paris) 1973, 128 :153-160.

[7] 7. Lhermitte J. Hypertrophie des muscles de la jambe consécutive à une lésion du nerf sciatique par balle. Rev Neurol (Paris) 1918, 33:56-58.

[8] 8. Lhermitte J, Albessard M. L'hypertrophie musculaire de l'a jambe dans la névrite sciatique. Rev Neurol (Paris) 1932, 83:78-90.

[9] 9. Mattle HP, Hess CW, Ludin H-P, Mumenthaler M. Isolated muscle hypertrophy as a sign of radicular or peripheral nerve injury. J Neurol Neurosurg Psychiatry 1991, 54:325-329.

[10] 10. Mielke U, Ricker K, Emser W, Boxler K. Unilateral calf enlargement following S__l radiculopathy. Muscle Nerve 1982, 5:434-438.

[11] 11. Montagna P, Martinelli P, Rasi F, Cirignotta F, Govoni E, Lugaresi E. Muscular hypertrophy after chronic radiculopathy. Arch Neurol 1984, 41 :397-398.

[12] 12. Pearn JH, Hudgson P. Anterior-horn cell degeneration and gross calf hypertrophy with adolescent onset. Lancet 1978, 1:1059-1061.

[13] 13. Ricker K, Rohkamm R, Moxley RT. Hypertrophy of the calf with S₁ radiculopathy. Arch Neurol 1988, 45:660-664.

[14] 14. Serratrice G, Pellissier JF, Marini JF, Valentin-Leccese P. Un cas de sciatique avec hypertrophie du mollet. Rev Neurol (Paris) 1989, 145:474-477.

[15] 15. Valenstein E, Watson RT, Parker JL. Myokymia, muscle hypertrophy and percussion myotonia in chronic recurrent polyneuropathy. Neurology 1978, 28:1130-1134.

[16] 16. Yamada M, Kano M, Chida K, Furukawa T, Tsukagoshi H. A symptomatic benign familial spinal muscular atrophy with hypertrophy of the calves and high creatine kinase levels. J Neurol Neurosurg Psychiatry 1988, 51:452-453.