A young football player complaining of chronic ank

 

Images

Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : ----------------
Academic Degree: ----------------
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mani Armand

 

Patient's Information

Gender : Male
Age : 26

 

Case Section

Muskuloskeletal System

 

Clinical Summary

A young football player complaining of chronic ankle pain with insidious onset and positive peroneal compression test (pain with compression of longus against brevis)

 

 

Imaging Procedures and Findings

C-shaped split configuration of peroneus brevis relative to peroneus longus in retrofibular groove near distal tip oflateral malleolus is evident. Surrounding fluid in association with tenosynovitis and increased signal in the substance of the tendon are noted.

 

Discussion

Laterally, the peroneus brevis and longus tendons share a common sheath as they pass under the lateral malleolus. Distal to the lateral malleolus, the tendons are enveloped with individual sheaths. The peroneus brevis tendon extends along the lateral aspect of the midfoot and inserts on the tuberosity at the lateral base of the fifth metatarsal. The peroneus longus tendon passes through a groove in the plantar surface of the cuboid, crosses under the midfoot deep to the master knot of Henry, and extends medially to insert on the plantar aspect of the medial cuneiform and the base of the first metatarsal, just lateral to the anterior tibial tendon insertion site. A trick for identifying the peroneal tendons is to think of the lateral malleolus as a race track. The peroneus brevis, being the shortest, hugs the inside curve and is thus closest to the fibula. The peroneus longus follows the outside of the curve, running posterior and inferior to the peroneus brevis. Unlike the medial ankle tendons, which are normally round or oval in axial cross section, the peroneus brevis can normally appear flattened as it passes around the lateral malleolus. The presence of increased signal in the substance of the tendon, or the presence of fluid in the surrounding sheath, aids in the diagnosis of pathology of the peroneal tendons. It is often helpful to examine the peroneal tendons over multi pie slices, using several imaging planes and sequences

 

Final Diagnosis

Peroneus brevis split syndrome

 

References

CT and MRI of the Whole body. John R. Haaga. Volume2

 

end faqaq

 

Go to top