Int J Anat Res 2015, 3(4):1745-48. ISSN 2321-4287 1745 Case Report
BILATERAL PRESENTATION OF TENSOR FASCIA SURALIS M USCLE
IN A M ALE CADAVER
Kusum Rajendra Gandhi *
1, Rajendra Namdeo W abale
2, M ujeebudeen Samsudeen
Farooqui
3.
ABSTRACT
Address for Correspondence: Dr. K. R. Gandhi, Assistant Professor, Depart ment of Anat omy, Rural M edical College, PIM S (DU), Loni, M aharasht ra, India. Phone No: +919689484225
E-M ail: gandhikusum.r@gmail.com
Tensor fascia suralis m uscle is an anom alous m uscle locat ed in poplit eal fossa. The m uscle m ay ar ise from any of t he ham st ring m uscles and is insert ed int o t he crural fascia or t endoclacaneus. We found t ensor fascia suralis m uscle in a m ale cadaver t aking origin from m edial side of t endon of biceps fem oris m uscle. The t endinous or igin w as t hen t ransform ed int o a w ell defined fusiform belly in t he roof of poplit eal fossa. Af t er t raversing dow nw ar ds and m edially t he m uscle again becam e t endinous t o get insert ed int o deep f ascia of leg. Bilat eral present at ion of t he anom alous m uscle is not yet docum ent ed in lit erat ure.
The anat om ical relat ion of t he m uscle explains it s great clinical im port ance. The t endinous origin w as ant er iorly relat ed t o sciat ic ner ve and t he m uscle belly t o t he t ibial nerve. Sur al nerve and short saphenous vein w ere in lat eral relat ion t o t he m uscle. Cont ract ion of m uscle in t he roof of poplit eal fossa m ay lead t o sciat ic, t ibial or sural nerve neuropat hy. The m uscle can confuse t he physician of a soft t issue m ass or an aberrant vessel. Hence, t he bilat eral presence of t ensor fascia sur alis m uscle is docum ent ed for furt her references.
Clinical Significance: The precise know ledge of anat om y of poplit eal region is m andat ory for t he sur geons t o per form safe and uncom plicat ed surgery in and around poplit eal f ossa and also f or r adiologist for corr ect radiographic int er pret at ions.
KEYW ORDS: Tensor Fascia Suralis M uscle, Anom alous M uscle, Neuropat hy, Aber rant Vessel.
INTRODUCTION
Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(4):1745-48. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.330
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Received: 05 Dec 2015 Accept ed: 19 Dec 2015 Peer Review : 05 Dec 2015 Published (O): 31 Dec 2015 Revised: None Published (P): 31 Dec 2015
Int ernat ional Journal of Anat omy and Research ISSN 2321-4287
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DOI: 10.16965/ ijar.2015.330
* 1 Assistant Professor, Depart ment of Anat omy, Rural M edical College, Pravara Inst it ute of M edical Sciences, Loni, Ahmednagar, M aharasht ra, India.
2 Professor and Head, Depart ment of Anat omy, Rural M edical College, Pravara Inst it ute of M edical Sciences, Loni, Ahmednagar, M aharasht ra, India.
3 Professor, Depart ment of Anat omy, Rural M edical College, Pravara Inst it ute of M edical Sciences, Loni, Ahmednagar, M aharasht ra, India.
Tensor fascia suralis m uscle (TFSM ) is a rare anom alous m uscle locat ed in t he poplit eal fossa. It is an anat omical variant w it h anoma-lous origin and insert ion [1]. TFSM m ay arise from t he dist al aspect of any of t he hamst ring muscles; majorit y of report ed cases st at es t he
or igin f r om dist al par t of sem it endinosus muscle. It may insert int o t he post erior fascia of t he leg, int o t he medial head of gast rocnemius or t hrough a t hin long t endon int o t he superfi-cial part of t he t endo calcaneous [2-5].
Int J Anat Res 2015, 3(4):1745-48. ISSN 2321-4287 1746
Kusum Rajendra Gandhi et al. BILATERAL PRESENTATION OF TENSOR FASCIA SURALIS M USCLE IN A M ALE CADAVER: A CASE REPORT.
CASE REPORT
our depart m ent . The case w as discussed t o enhance t he know ledge of t he morphology of t he poplit eal region. Such morphological varia-t ions may lead varia-t o error in bovaria-t h diagnosis and t reat m ent . Hence, t his report w ill guide t he radiologist s and surgeons during diagnosis and t reat ment of muscular diseases in and around poplit eal fossa.
During rout ine educat ional dissect ion of t he low er limb by medical st udent s in our depart -m en t , a v ar i an t -m uscle w as f ou n d in t h e poplit eal region. The anomalous m uscle w as lo cat ed b ilat er ally im m edi at ely under t he poplit eal fascia in a 54 year old male cadaver bilat erally. After careful dissect ion and clean-ing t he superficial fascia and fat , t he muscle w as t raced t hroughout t o locat e it s at t achment s, course and relat ions (Fig.1).
Fig. 1: The bilat erally pr esent f usifor m t ensor fascia sur alis m uscle in t he r oof of poplit eal fossa indicat ed by red star. The m uscle is taking origin from t he t endon of biceps fem oris. Blue ar row show s t he insert ion of fusiform belly of the anam olous m uscle. The sciat ic nerve (yellow arrow ), com m on peroneal nerve (yellow dash arr ow ) and t ibial nerve (yellow st ar) is in lat eral relat ion of t he t ensor fascia suralis m uscle.
On left side, TFSM w as t aking origin from t he ischial t uberosit y along w it h long head of biceps femoris and semit endinosus muscle in t he form of a common t endon inst ead of arising from a hamst ring as ment ioned above. The lengt h of t his t endinous origin w as 27.5 cm. In t he roof of
popliteal fossa, t he t endon was t ransformed int o a w ell defined fusiform muscle belly having t he dimensions (L-12.5 cm, w idt h 1.7cm and t hick-ness 1.6 cm). Aft er running dist ally and medi-ally t he muscle belly t ransformed again int o a long t endon (L- 5.5 cm) w hich fanned out t o be insert ed int o t he deeper part of t he deep fascia of crural region. The t ot al lengt h of t he muscle w as 45.5 cm. The sciat ic nerve w as in ant erior relat ion t o t he t endinous origin and t ibial nerve w as ant eriorly placed t o t he fusiform m uscle belly.
Fig. 2: Tensor Fascia Suralis M uscle (red st ar) is taking origin f rom m edial aspect of biceps f em or is m uscle and is inser t ed int o t he deeper part of sural fascia (blue arrow ). Sciat ic nerve and com m on peroneal nerve are in ant erior relat ion of t he anam olous m uscle and t he sm all saphenous vein (blue st ar) and sural nerve (yellow st ar) lies lat erally.
Int J Anat Res 2015, 3(4):1745-48. ISSN 2321-4287 1747 DISCUSSION
The anat omical relat ions of t endon of 5.5 and 5 cm are of great clinical import ance. Superior part of t he muscle w as sit uat ed bet w een t he biceps femoris and semit endinosus; t he low er part , it s t endon w as post erior t o t he gast rocnemius; t he poplit eal vessels and t ibial nerve w ere lying ant erior to t he muscle. The sural nerve and short saphenous vein w ere in immediat e lat eral rela-t ion rela-t o rela-t he rela-t ensor fascia suralis muscle on borela-t h right and left sides.
The present findings are similar t o t he first case report ed by KELCH (1813). He discovered a muscle w hich originat ed from t he medial aspect of t he long head of t he biceps f em or is and insert ed int o t he t endo calcaneus and t ermed it t ensor fasciae suralis [2-6]. According t o st at e-ment s of previous aut hors, a muscle which origi-nat es from semit endinosus, long head of t he biceps femoris or from bot h of t he above-men-t ioned muscle and inserabove-men-t s inabove-men-t o above-men-t he sural fascia or t he t endo calcaneus can be t erm ed t he tensor fasciae suralis [2-4]. Consequent ly, t he m u scle f ou nd i n t h is case r ep or t sh al l be regarded as t ensor fasciae suralis. The TFSM have been report ed unilat erally in lit erat ure sum m ar ized in Table 1. To t he best of our know ledge, bilat eral present ation of TFSM is not document ed in lit erat ure t ill dat e.
Table 1: Details of or igin and insert ion of TFSM described by Previous Aut hors.
S No Aut hor Year Origin Insert ion
1 Kelch [4] 1813 Bi ceps femori s tend ocal caneus
2 Halliburt on [4] 1881 Bi ceps femori s tend ocal caneus
3 Turner [4] 1884 -5 Bi ceps femor i s a nd l i nea
aspar a tend ocal caneus
4 Gruber [4 ] 1897 Bi ceps femori s Sur al fasci a
5 Schaeffer [4] 1913 Bi ceps femori s Sur al fasci a
6 Kaw ai [4 ] 1935 Semi tend i nosus Sur al fasci a
7 M ogi [4] 1940 Semi tend i nosus Sur al fasci a
8 Nonoka [4] 1954
Two heads-l atera l fro m bi ceps femor i s an d
med i al head from semi tend i nosus
Sur al fasci a
10 Gupt a RK e t al [3] 2006
Two heads Bi ceps Femor i s and Semi tend i nosus
Between th e two h eads of Gastrocnemi us
11 Present st udy 2015 Tend on of l ong head of
Bi ceps femori s
Deep er par t o f Sura l fasci a.
9 M iyauchi R [4] 1985 Sur al fasci a
Two heads-medi al fr om semi tend i nosus l atr al fr om l ong head o f
the bi cep s femor i s.
The incidence of such anomalous muscle-t don unit is of great clinical import ance. The t en-dinous origin of t he muscle w as post erior t o t he sciat ic nerve and t he t hick fusiform belly w as post erior t o t he t ibial nerve and sural nerve; t he cont ract ion of t ensor fascia suralis m uscle in such relat ion may lead t o compression of any of t hese nerves leading t o ent rapment neuropa-t hies. Pain and paresneuropa-t hasia along neuropa-t he course of t hese nerves w ill be felt in t hese pat ient s [2-4].
Chason et al argued t hat t he mass like presen-t apresen-t ion of presen-t his anomaly could relapresen-t e presen-t o presen-t he size and lengt h of t he port ion of t he muscle t hat ext ends t hrough t he poplit eal fossa. Apart from it s clinical present at ion, it can cause errors in t he int erpret at ion of im aging st udies. When prominent , t his muscle may be mistaken for a m ass, on it s tendon may be mist aken for an aberr ant vessel. Fur t herm ore, because t he t issue charact erist ics are t hat of eit her normal muscle or t endon, it may be missed alt oget her on rout ine im aging st udies [ 1,6]. Since t he poplit eal vein is superficial t o t he art ery in t he middle of poplit eal fossa, it is possible t hat t he variant muscle could have a compressive effect on poplit eal vein [5]. Even t he t ibial nerve is superficial t o poplit eal vein w hich can also be compressed along w it h poplit eal vein.
Int J Anat Res 2015, 3(4):1745-48. ISSN 2321-4287 1748
Kusum Rajendra Gandhi et al. BILATERAL PRESENTATION OF TENSOR FASCIA SURALIS M USCLE IN A M ALE CADAVER: A CASE REPORT.
CONCLUSION
Conflicts of Interests: None
REFERENCES
The present case w ill add t o t he exist ing know l-edge of anat omy of t he poplit eal region and w ill guide t he surgeon during various operat ive procedures in and around t he knee. It w ill also be helpful t o radiologist in int erpret at ion of t he ult rasonographic and M RI im ages correct ly. Hence, proper know ledge of muscular variat ions i s essen t ial no t on l y f o r an at o m i st s an d surgeons, but also for radiologist .
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Ku su m Raj end r a Gan d h i , Raj en d r a Nam d eo W ab al e, M ujeebudeen Samsudeen Farooqui. BILATERAL PRESENTATION OF TENSOR FASCIA SURALIS M USCLE IN A M ALE CADAVER: A CASE REPORT. Int J Anat Res 2015;3(4):1745-1748. DO I:
