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    Ankle Tendon Injury

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    Anang Fajar
    This document discusses MRI and ultrasound imaging of tendon injuries around the ankle joint. It provides examples of images showing normal anatomy as well as various pathologies like tendinosis, tenosynovitis, tears, and anatomical variations of the peroneal and posterior tibial tendons. The document emphasizes the importance of understanding anatomy when evaluating these types of ankle injuries with imaging. It also notes that ultrasound can detect dynamic components like subluxation while MRI allows for multiplanar reconstruction, and either modality is generally sufficient.

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    Ankle Tendon Injury

    Uploaded by

    Anang Fajar
    47 views7 pages
    This document discusses MRI and ultrasound imaging of tendon injuries around the ankle joint. It provides examples of images showing normal anatomy as well as various pathologies like tendinosis, tenosynovitis, tears, and anatomical variations of the peroneal and posterior tibial tendons. The document emphasizes the importance of understanding anatomy when evaluating these types of ankle injuries with imaging. It also notes that ultrasound can detect dynamic components like subluxation while MRI allows for multiplanar reconstruction, and either modality is generally sufficient.

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    This document discusses MRI and ultrasound imaging of tendon injuries around the ankle joint. It provides examples of images showing normal anatomy as well as various pathologies like tendinosis, tenosynovitis, tears, and anatomical variations of the peroneal and posterior tibial tendons. The document emphasizes the importance of understanding anatomy when evaluating these types of ankle injuries with imaging. It also notes that ultrasound can detect dynamic components like subluxation while MRI allows for multiplanar reconstruction, and either modality is generally sufficient.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views7 pages

    Ankle Tendon Injury

    Uploaded by

    Anang Fajar
    This document discusses MRI and ultrasound imaging of tendon injuries around the ankle joint. It provides examples of images showing normal anatomy as well as various pathologies like tendinosis, tenosynovitis, tears, and anatomical variations of the peroneal and posterior tibial tendons. The document emphasizes the importance of understanding anatomy when evaluating these types of ankle injuries with imaging. It also notes that ultrasound can detect dynamic components like subluxation while MRI allows for multiplanar reconstruction, and either modality is generally sufficient.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 7

    1/9/2013

    US or MRI? Tendon Injuries around the ankle joint Either will suffice
    High resolution technique US has dynamic component (subluxation) MR particularly good for peroneus longus 3D volumetric acquisition with facility for multiplanar reconstruction (MPR)

    James F Griffith
    The Chinese University of Hong Kong

    Tendinosis

    / peritendinitis

    Tenosynovitis

    Normal Acute Normal Subacute / Chronic

    Mild

    Moderate

    Severe

    Lateral tendons the peroneals

    Peroneus quartus muscle tendon

    10% of ankle MR studies

    Cheung YY et al, Radiology 1977

    1/9/2013

    Peroneus quartus muscle tendon

    Superior reticacular tear

    No effect

    Crowding

    Mimic tendon tear

    Superior retinacular tear with subluxation

    Peroneal retinacular tear with subluxation

    Peroneal tendinosis

    Peroneal tenosynovitis

    1/9/2013

    Peroneus brevis tear and split

    Hypertropied peroneal tubercle, os peroneum

    Peroneal tubercle Variable in size Larger more likely to give problems, esp if > 5mm depth
    Muehleman C et al, Clinical Anatomy 2009

    Hypertropied peroneal tubercle

    Hypertropied peroneal tubercle

    Hypertropied peroneal tubercle

    Os peroneum

    Associated with tears and tendinosis of peroneus longus Bipartite in 20%

    1/9/2013

    Os peroneum 2 weeks later

    Diastasis of biparite os peroneum

    3/52 2/52

    Initial

    3/52

    Retracted os peroneum 2o to peroneus longus tear

    Medial tendons Tom, Dick and Harry

    Posterior tibial tendinosis

    Posterior tibial tendon tear

    Posterior tibial tendinosis with tear

    1/9/2013

    Posterior tibial insertion

    Posterior tendons Achilles

    MR image

    Pes planus Cornuate navicular bone Accessory navicular bone Thickening superomedial component spring ligament (>5mm)

    Achilles tendon normal

    Mid-portion Achilles tendinosis

    Uppermid Achilles tendinosis

    Insertional Achilles tendinosis

    1/9/2013

    Achilles insertional tendinosis

    Insertional Achilles tendinosis

    Insertional Achilles tendinosis

    Insertional Achilles tendonosis

    Should not use terms like Haglunds disease, deformity or tendinitis Calcaneal bump is as common in asymptomatic as symptomatic patients Achilles tendinosis or tendinopathy, paratenonitis or paratendinopathy are appropriate terms

    Van Dijk CN et al, Knee Surg Sports Traumatol 2011 Kang S et al. Foot & Ankle Int 2012

    Achilles paratendonitis

    Achilles paratenonitis - acute

    Acute

    Chronic T1 SE axial T2 FS axial

    1/9/2013

    Achilles tendon tear

    Achilles tendon tear


    Extended field-of-view ultrasound

    Conclusion
    Remember anatomy, anatomy, anatomy ..!! Anatomical peculiarities (variants, retinacula, ossicles) Tendinosis? Peritendinitis? Tenosynovitis (or Paratenonitis)? Tendon tear?

    Thank You !!

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