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Sonography of Ankle Tendon Impingement with Surgical Correlation

Monisha Shetty1, David P. Fessell1, John E. Femino2, Jon A. Jacobson1, John Lin1,3 and David Jamadar1

1 Department of Radiology, University of Michigan Medical Center, Taubman Center 2808, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0326.
2 Department of Orthopedic Surgery, University of Michigan Medical Center, Taubman Center, Ann Arbor, MI 48109-0326.
3 Present address: Valley Radiology, Ltd., 5322 W. Northern Ave., Glendale, AZ 85301.



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  		Fig. 1A. —32-year-old woman with posteromedial ankle pain. Longitudinal sonogram of posterior tibial tendon (arrowheads) shows small spur in retromalleolar groove of tibia (arrow) causing impingement of posterior tibial tendon.

 


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  		Fig. 1B. —32-year-old woman with posteromedial ankle pain. Coronal T1-weighted MR image shows osteophyte at posteromedial tibia (arrow). Osteophyte was not well visualized on other MR sequences or on images obtained in other planes (not shown).

 


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  		Fig. 2. —53-year-old man with pain during palpation of extensor tendons. Transverse sonogram shows enlarged extensor digitorum longus tendon (arrowheads) with small amount of adjacent fluid (curved arrow) caused by impingement of talar osteophyte (straight arrow).

 


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  		Fig. 3A. —27-year-old man with medial malleolar fracture. Transverse sonogram shows fracture fragment (arrow) from retromalleolar groove impinging on posterior tibial tendon (arrowheads).

 


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  		Fig. 3B. —27-year-old man with medial malleolar fracture. Transverse sonogram shows posterior tibial tendon (between cursors) with longitudinal split (arrow).

 


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  		Fig. 3C. —27-year-old man with medial malleolar fracture. Axial T1-weighted MR image shows medial malleolar fracture fragment (small arrows) adjacent to posterior tibial tendon (large arrow).

 


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  		Fig. 3D. —27-year-old man with medial malleolar fracture. Axial proton density—weighted MR image shows cleft in posterior tibial tendon (arrow) with surrounding high-signal fluid.

 


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  		Fig. 3E. —27-year-old man with medial malleolar fracture. Coronal T1-weighted MR image shows fracture fragment (arrow) and adjacent posterior tibial tendon (arrowheads).

 


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  		Fig. 4A. —40-year-old woman with lateral ankle pain after tibiotalar joint fusion. Lateral radiograph shows multiple screws with one screw head (arrow) posterior to fibula in expected location of peroneal tendons.

 


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  		Fig. 4B. —40-year-old woman with lateral ankle pain after tibiotalar joint fusion. Longitudinal sonogram obtained at lateral ankle shows echogenic screw head (large arrow) deviating peroneal tendons (arrowheads). Reverberation artifact is shown deep relative to screw head (small arrows).

 


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  		Fig. 5A. —59-year-old woman with anterior ankle pain. Lateral radiograph shows interlocking screw head (arrow) anterior to cortex of distal tibia.

 


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  		Fig. 5B. —59-year-old woman with anterior ankle pain. Longitudinal sonogram obtained at anterior ankle shows echogenic screw head (large arrow) impinging on anterior tibial tendon (arrowheads). Reverberation artifact is shown deep relative to screw head. Note associated tenosynovitis of anterior tibial tendon (small arrows).

 

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