1
|
Luther L, McGlone PJ, Hardacker KD, Alsoof D, Hayda RA, Terek RM. Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report. Orthop Rev (Pavia) 2024; 16:91505. [PMID: 38469575 PMCID: PMC10927312 DOI: 10.52965/001c.91505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/03/2023] [Indexed: 03/13/2024] Open
Abstract
Case A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Conclusion Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.
Collapse
Affiliation(s)
| | | | | | - Daniel Alsoof
- Corresponding Author: Daniel Alsoof Department of Orthopaedic Surgery Brown University, Warren Alpert School of Medicine 1 Kettle Point Avenue Providence, RI 02906
| | | | | |
Collapse
|
2
|
Wu LJ, Jiang SG, Cui LK, Zhang Q, Zhang L, Kang K, Bai YM, Gao SJ. A Retrospective Study of the Risk Factors for Postoperative Foot or Ankle Pain in 90 Patients with Varus Osteoarthritis of the Knee who Underwent Total Knee Arthroplasty. Med Sci Monit 2021; 27:e932796. [PMID: 34764234 PMCID: PMC8594133 DOI: 10.12659/msm.932796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The reasons for foot and ankle pain following total knee arthroplasty (TKA) for knee varus osteoarthritis are unknown. This retrospective study aimed to investigate the risk factors for postoperative foot and ankle pain in patients with varus osteoarthritis of the knee who underwent TKA. Material/Methods We enrolled 90 patients who underwent TKA for varus knee osteoarthritis. The visual analog scale (VAS) was used to evaluate patients’ foot or ankle pain before and after surgery. The correlation between independent variables (eg, age, sex, body mass index [BMI], ankle osteoarthritis, and varus angle) and foot and ankle pain in patients with osteoarthritis of the knee was measured. Moreover, radiological changes were compared between the groups with and without worsened pain. Results No significant difference in VAS was found between patients <60 and ≥60 years of age (P>0.05). Male sex and BMI <30 kg/m2 were weakly correlated with preoperative foot or ankle pain. However, patients with varus of ≥6° and preexisting ankle osteoarthritis had a higher incidence of foot or ankle pain before surgery. Moreover, no significant differences in radiological changes were found between the groups with and without worsened foot or ankle pain after surgery (P>0.05). Conclusions In male patients with osteoarthritis of the knee, a BMI <30 kg/m2, varus of <6°, and no preexisting ankle osteoarthritis were protective factors for foot and ankle pain. TKA corrected knee and ankle malalignment. Therefore, postoperative foot and ankle pain was not associated only with TKA surgery.
Collapse
Affiliation(s)
- Li-Jie Wu
- Department of Joint Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Shi-Gang Jiang
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lu-Kuan Cui
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Qian Zhang
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lei Zhang
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Kai Kang
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yu-Ming Bai
- Department of Jiont Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Shi-Jun Gao
- Department of Joint Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| |
Collapse
|
3
|
Abstract
Heel pain presents frequently to primary care, commonly affecting athletic and elderly patients. Its presentation can be a common source of confusion for clinicians given the wide variety of differential diagnoses and the similarities in presenting symptoms and signs. This review classifies heel pain according to site of pain and explores the common pathologies clinicians may encounter. A brief summary of common imaging modalities used is provided. The literature is reviewed to guide evidence-based practice and to provide a framework to help clinicians investigate and manage heel pain before onward referral for specialist intervention. A linked article detailing the imaging of heel pain is included in this issue ( https://doi.org/10.12968/hmed.2019.80.4.192 ).
Collapse
Affiliation(s)
- Usman N Bhatty
- ST6 Registrar in Trauma and Orthopaedic Surgery, Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH
| | - Shah Hm Khan
- Consultant Musculoskeletal Radiologist, Department of Radiology, East Lancashire Teaching Hospitals NHS Trust, Blackburn and Honorary Senior Lecturer, University of Central Lancashire, Preston
| | - Aamir I Zubairy
- Consultant Trauma and Orthopaedic Surgeon, Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn
| |
Collapse
|
4
|
Mansur NSB, Baumfeld TS, Lemos AVKC, Azevedo RMD, Fonseca LFD, Doering J, Nery CAS. Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series. ACTA ACUST UNITED AC 2019; 65:370-374. [PMID: 30994835 DOI: 10.1590/1806-9282.65.3.370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.
Collapse
Affiliation(s)
| | - Tiago Soares Baumfeld
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | | | - Rafael Mohriak de Azevedo
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Lucas Furtado da Fonseca
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Juliana Doering
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Caio Augusto Souza Nery
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| |
Collapse
|
5
|
Kose O, May H, Acar B, Unal M. Symptomatic os talus secundarius: a case report and review of the literature. Skeletal Radiol 2018; 47:553-562. [PMID: 29098389 DOI: 10.1007/s00256-017-2803-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Os talus secundarius is an extremely rare accessory ossicle located at the lateral aspect of the talus just anterior to the fibula. Although rarely seen, it may cause lateral-sided chronic ankle pain. Only a few cases of symptomatic os talus secundarius have been reported to date. Herein, a 42-year-old male patient with symptomatic os talus secundarius is presented, and its imaging findings, differential diagnosis, and treatment are discussed. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Ozkan Kose
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, 07100, Soğuksu Muratpaşa, Antalya, Turkey.
| | - Hasan May
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, 07100, Soğuksu Muratpaşa, Antalya, Turkey
| | - Baver Acar
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, 07100, Soğuksu Muratpaşa, Antalya, Turkey
| | - Melih Unal
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, 07100, Soğuksu Muratpaşa, Antalya, Turkey
| |
Collapse
|
6
|
Abstract
Objective: The aim of this article is to review the clinical and imaging features of symptomatic hypertrophic (TP) in a cohort of symptomatic patients. Materials and Methods: Twenty-three patients with chronic lateral ankle pain were retrospectively included in our study group. Patients underwent ultrasound (US), (cone beam) computed tomography (CB)CT or magnetic resonance (MR) examination or a combination of these examinations with a standardized protocol. Patients with an underlying fracture were excluded. The following parameters were recorded: clinical history, size of the TP on different imaging modalities, presence and grade of peroneus brevis/longus tenosynovitis and the presence of bone marrow edema at the os calcaneus on magnetic resonance imaging (MRI). Results: The mean width of the hypertrophic TP was 5.6 mm. Combined tenosynovitis of the peroneus longus (PL) and brevis tendon (PB) was most common, followed by isolated PL and finally PB tenosynovitis. Grade 1 tenosynovitis was most common. BME was present in 53% of the cases. Conclusion: The width of the TP is may be evaluated on the (oblique) coronal US, (CB)CT or non-fat suppressed MR images. Both US and MRI may detect and grade involvement of the peroneal tendons. By the use of fluid sensitive sequences, MRI may be of additional value to detect bone marrow edema as result of repetitive friction.
Collapse
|
7
|
Multiple abnormalities in the feet and associated changes elsewhere in the skeleton: The case of 3A-7 from a Capsian Site in Algeria. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:199-212. [PMID: 28549622 DOI: 10.1016/j.jchb.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/03/2017] [Indexed: 11/22/2022]
Abstract
A skeleton with a number of abnormalities is described involving full discussion of alternative diagnoses. In this complex case, the primary diagnosis is of avulsion of the stem of the bifurcate ligament causing a fracture of the anterior process of the calcaneus. The bilateral fracture identified in Skeleton 3A-7 from Site 12, a Capsian site in Algeria, is a result of the feet being inverted and plantar flexed: the fracture is prone to non-union, which is asymmetrical here. There is also a separate anatomical variation of the feet, 3rd cuneiform and 3rd metatarsal coalition, which was not the cause of trauma. The bifurcate ligament is a major stabilizer of the lateral transverse talar joint, and the trauma could lead to further issues: however, multiple other traumatic changes in 3A-7 most likely occurred at the same time, rather than as the result of pre-existing foot trauma. The asymmetry of the calcaneal condition and asymmetry of the sequelae of the original trauma led to long bone asymmetry, the result of locomotor difficulties.
Collapse
|
8
|
Opdam KTM, van Dijk PAD, Stufkens SAS, van Dijk CN. The Peroneus Quartus Muscle in a Locking Phenomenon of the Ankle: A Case Report. J Foot Ankle Surg 2016; 56:108-111. [PMID: 27625201 DOI: 10.1053/j.jfas.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 02/03/2023]
Abstract
We present the case of a 64-year-old female who was referred to us with an unexplained clicking and locking phenomenon of the right ankle. The magnetic resonance imaging findings suggested a longitudinal tear of the peroneus brevis tendon. During tendoscopy, not only was a Raikin type B intrasheath tendon subluxation visible, but also a peroneus quartus muscle. The peroneus brevis tear was tubularized and the peroneus quartus muscle resected, which resolved the patient's complaints.
Collapse
Affiliation(s)
- Kim T M Opdam
- PhD Candidate, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | - Pim A D van Dijk
- PhD Candidate, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands; Orthopedic Surgeon-Consultant Orthopaedic Surgeon, Flevoziekenhuis, Almere, The Netherlands; Postdoctoral Research Fellow, Department of Orthopaedic Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - C Niek van Dijk
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands; Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam (ORCA), Academic Medical Center, University of Amsterdam, The Netherlands
| |
Collapse
|
9
|
A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study. ACTA ACUST UNITED AC 2015; 20:587-91. [DOI: 10.1016/j.math.2015.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/18/2015] [Accepted: 01/23/2015] [Indexed: 12/28/2022]
|
10
|
Bilgili MG, Kaynak G, Botanlioğlu H, Basaran SH, Ercin E, Baca E, Uzun I. Peroneus quartus: prevalance and clinical importance. Arch Orthop Trauma Surg 2014; 134:481-7. [PMID: 24525795 DOI: 10.1007/s00402-014-1937-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures. MATERIAL AND METHOD We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon. RESULTS The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up. CONCLUSION Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.
Collapse
Affiliation(s)
- Mustafa Gökhan Bilgili
- Department of Orthopaedics and Traumatology, Dr Sadi Konuk Research and Training Hospital, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147, Istanbul, Turkey,
| | | | | | | | | | | | | |
Collapse
|
11
|
Morris H, Grant K, Khanna G, White AJ. Gout in a 15-year-old boy with juvenile idiopathic arthritis: a case study. Pediatr Rheumatol Online J 2014; 12:1. [PMID: 24393408 PMCID: PMC3895757 DOI: 10.1186/1546-0096-12-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/24/2013] [Indexed: 02/06/2023] Open
Abstract
Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for joint pain. In this case, an obese 15-year-old male was diagnosed with gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of gout from this patient's differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients' BMI was 47.4, and he was also mis-diagnosed with osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple surgical procedures before the key history of increased pain with red meat ingestion, noticed by the patient, and a subsequent elevated uric acid confirmed his ultimate diagnosis. With the increased prevalence of obesity in the adolescent population, the diagnosis of gout should be an important consideration in the differential diagnosis for an arthritic joint in an overweight patient, regardless of age.
Collapse
Affiliation(s)
- Hallie Morris
- Washington University School of Medicine, WUSM IV, St Louis, Missouri, USA
| | - Kristen Grant
- Boston Combined Residency Program, PGY1, Boston, Mass, USA
| | - Geetika Khanna
- Division of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrew J White
- Division of Pediatric Rheumatology, Washington University School of Medicine, St Louis, Missouri, USA.
| |
Collapse
|
12
|
Taneja AK, Simeone FJ, Chang CY, Kumar V, Daley S, Bredella MA, Torriani M. Peroneal tendon abnormalities in subjects with an enlarged peroneal tubercle. Skeletal Radiol 2013; 42:1703-9. [PMID: 24057440 DOI: 10.1007/s00256-013-1725-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/29/2013] [Accepted: 08/26/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between inframalleolar peroneal tendon abnormalities and an enlarged peroneal tubercle. MATERIALS AND METHODS Two independent readers evaluated consecutive ankle MR imaging studies to classify inframalleolar peroneal tendon findings as normal, tenosynovitis, partial tear or complete tear. The size and morphology of the peroneal tubercle was also recorded. We performed statistical analyses for inter-observer agreement and to assess differences in peroneal tubercle size between groups with and without peroneal tendon abnormalities. RESULTS The study group comprised 121 subjects (mean age, 45.5 years) of whom 28% (34 out of 121) had lateral ankle symptoms. The peroneal tubercle was absent in 56% of subjects (68 out of 121). In subjects with a peroneal tubercle (>0 mm), the mean size was 3.5 mm (37% triangular and 7% plateau-shaped). Male subjects had significantly larger mean peroneal tubercle size than female subjects (2.1 ± 2.5 vs 1.2 ± 1.9 mm, P = 0.04). Overall, 26% (32 out of 121) of subjects had some peroneal tendon abnormality: 17% (20 out of 121) had tenosynovitis and 17 % (20 out of 121) had partial thickness tears. The peroneal tubercle size was significantly larger in subjects with peroneal tendon partial tears (P = 0.036), tenosynovitis (P < 0.001), and when both abnormalities were present (P = 0.007). ROC statistic showed 73% sensitivity and 74% specificity for detection of partial tears for peroneal tubercle size ≥4.3 mm. CONCLUSION Our study shows a significantly larger peroneal tubercle in subjects with inframalleolar peroneal tendon abnormalities. A cut-off of 4.3 mm showed good sensitivity and specificity for the presence of partial tears of the peroneal tendon.
Collapse
Affiliation(s)
- Atul K Taneja
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6048, Boston, MA, 02114, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Clarkson MJ, Fox JN, Atsas S, Daney BT, Dodson SC, Lambert HW. Clinical implications of novel variants of the fibularis (peroneus) quartus muscle inserting onto the cuboid bone: peroneocuboideus and peroneocalcaneocuboideus. J Foot Ankle Surg 2013; 52:118-21. [PMID: 23153781 PMCID: PMC7203639 DOI: 10.1053/j.jfas.2012.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Indexed: 02/03/2023]
Abstract
Two variants of the fibularis (peroneus) quartus muscle were identified and photographed in the legs of a 70-year-old white male cadaver. A rare peroneocuboideus (fibulocuboideus) muscle (as described by Chudzinski) and a novel peroneocalcaneocuboideus (fibulocalcaneocuboideus) muscle was found in the right and left leg, respectively. The latter muscle has not been previously reported and was termed "peroneocalcaneocuboideus" on the basis of its origin and insertions. Also, the distal attachment of both muscles inserted onto the distal lip of the peroneal sulcus of the cuboid bone, which differs from the historical data. The insertion of the peroneocuboideus muscle was previously described as being at the tuberosity of the cuboid bone or, simply, the lateral surface of the cuboid. Therefore, the present case study provides the first gross anatomic photographs of these variant leg muscles along their entire length, identifies a novel fibularis quartus variant, and describes a new insertion site for the peroneocuboideus muscle. Throughout our report, the historical data are reviewed to list the prevalence and describe the clinical implications of the fibularis quartus muscle and its variants. The presence of variant fibularis quartus muscles has been known to cause lateral ankle pain and stenosis, ankle instability, fibular tenosynovitis, subluxation of the fibular (peroneal) tendons, and longitudinal splitting of the fibularis brevis tendon in radiologic and case studies. Therefore, surgeons, radiologists, and clinicians should be aware of these variant muscles when considering various diagnoses, interpreting radiographs, and pursuing surgical intervention to relieve lateral ankle pathologic features.
Collapse
Affiliation(s)
- Mackenzie J. Clarkson
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV
| | - Jacob N. Fox
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV
| | - Stavros Atsas
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV
| | - Blake T. Daney
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV,Department of Orthopaedic Surgery, Akron General Medical Center, Akron, OH
| | - Sean C. Dodson
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV
| | - H. Wayne Lambert
- Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown, WV
| |
Collapse
|
14
|
Didolkar MM, Malone AL, Nunley JA, Dodd LG, Helms CA. Pseudotear of the peroneus longus tendon on MRI, secondary to a fibrocartilaginous node. Skeletal Radiol 2012; 41:1419-25. [PMID: 22349597 DOI: 10.1007/s00256-012-1373-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/25/2012] [Accepted: 01/25/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to identify the presence of a fibrocartilaginous node within the distal peroneus longus tendon (PLT) just proximal to the cubital tunnel and correlate this with MRI signal characteristics of the distal PLT, which could result in a pseudotear appearance on MRI. We correlated imaging characteristics with pathologic specimens. MATERIALS AND METHODS Institutional review board approval was obtained. Retrospectively, 91 ankle MRIs utilizing a standard ankle protocol were reviewed by two musculoskeletal radiologists. Four cadaver ankles were imaged using a standard ankle MRI protocol and reviewed by the same radiologists. All the MRIs were examined for signal changes in the PLT. The cadaver ankles then underwent PLT dissection by an orthopaedic surgeon, and a pathologic review was undertaken by a pathologist with orthopaedic specialization, who looked for an os peroneum or proposed fibrocartilaginous node relating to the signal change found on the MRIs. RESULTS In the 91 ankle MRI studies, the PLT demonstrated normal low and increased signals. On the fat-saturated T2-weighted sequence, 76 (83.5%) ankles demonstrated low signal and 15 (16.5%) demonstrated increased signal. Of the cadaver ankle MRIs, all four demonstrated increased signal within the PLT; three contained a fibrocartilaginous node and one contained an os peroneum in that same region. CONCLUSIONS The MRI signal of the PLT can change with the presence of a fibrocartilaginous node, which may be due to the molecular and chemical content of the fibrocartilage. This node increases the MRI signal in the distal PLT and gives the appearance of a pseudotear.
Collapse
Affiliation(s)
- Manjiri M Didolkar
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | | | | | | | | |
Collapse
|