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Diagnostic and Therapeutic Ankle Tenography

Outcomes and Complications

¹ Southwest Radiology Associates, 1200 Postoak Blvd., Ste. 426, Houston, TX 77056.
² Mallinkckrodt Institute of Radiology, Washington University School of Medicine, 520 S. Kingshighway Blvd., St. Louis, MO 63110.
³ Diagnostic Clinic, P. O. Box 2901, Largo, FL 33779-2901.
⁴ Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Ste. 11300 W. Pavilion, St. Louis, MO 63110.

OBJECTIVE. The purpose of our study was to evaluate tenography complications and outcomes in a large series.

MATERIALS AND METHODS. Of 144 tenograms obtained consecutively from May 5, 1995, to March 17, 1997, 111 were located for at least a 6-month follow-up; 65 were posterior tibial, 39 peroneal, two anterior tibial, three flexor digitorum longus, and two flexor hallucis longus tenograms. Tenography was performed fluoroscopically with contrast material and anesthetic followed by steroid placement into tendon sheaths.

RESULTS. Of 65 patients undergoing posterior tibial tenography, 31 (48%) had complete or near-complete symptom resolution; 17 (26%) had no relief. Seventeen patients (26%) had initial relief with the subsequent return of pain to the pretenography level. Of 39 patients undergoing peroneal tenography, 18 (46%) had complete or near-complete symptom resolution; 10 (26%) had no and 11 (28%) had initial relief with subsequent pretenography pain return. Of three patients undergoing flexor digitorum longus tenography, one had complete, one had no, and one had initial relief with complete pretenography pain return. One of two patients who underwent flexor hallucis longus tenography had no relief; the other had initial relief with complete pain return. Two patients who underwent anterior tibial tenography had complete pain relief. We found no correlation between degree of tenosynovitis shown radiographically and therapeutic improvement with anesthetic and steroid injection. Tenography complications included one posterior tibial tendon rupture (0.89%) and 14 patients with skin discoloration at the tendon sheath injection site.

CONCLUSION. Forty-seven percent of surgical candidates whose condition was refractory to conservative therapy had complete or near-complete prolonged symptom relief after tenography. In appropriate patients, tenography is excellent therapy for tenosynovitis. Certain precautions make complications rare.

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				J.-B. Na, A. G. Bergman, L. M. Oloff, and C. F. Beaulieu The Flexor Hallucis Longus: Tenographic Technique and Correlation of Imaging Findings with Surgery in 39 Ankles Radiology, September 1, 2005; 236(3): 974 - 982. [Abstract] [Full Text] [PDF]