Anterior Tibialis Tenosynovitis

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Anterior Tibialis Tenosynovitis

Authors, Editors, Case Information Author: Jaime Dougherty, DO Affiliation: Cooper Medical School of Rowan University Co Author(s): Altamash Raja, DO, RMSK, CSCS Senior Editor: Laura Mattson, DO Clinical Vignette: A 46-year-old male presented with 9 months of pain and swelling over the anterior aspect of the right ankle. He endorsed the pain with passive and active range of motion with tenderness to palpation over the tibiotalar joint and lateral malleolus. Type of Probe Used: Linear transducer 15-4 MHz and 19-5 MHZ Unlabeled Short Axis View of the Left Anterior Tibialis Tendon Unlabeled Short Axis View of the Left Anterior Tibialis Tendon Labeled Short Axis View of the Left Anterior Tibialis Tendon Labeled Short Axis View of the Left Anterior Tibialis Tendon with tendon sheath effusion and synovial thickening just proximal to anteror tibiotalar joint. Unlabeled Long Axis View of the Left Anterior Tibialis Tendon Unlabeled Long Axis View of the Left Anterior Tibialis Tendon Labeled Long Axis View of the Left Anterior Tibialis Tendon Labeled Long Axis View of the Left Anterior Tibialis Tendon with tendon sheath effusion. Note relatively preserved tendon architecture, with uniform tendon thickness, no significantly altered echogenicity, no tearing. Unlabeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler Unlabeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler Labeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler Labeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler with minimal amount of flow proximally and no significant hyperemia noted. #7 - Video View Video Short axis cine of the anterior tibialis tendon proximal to distal just proximal to the ankle joint with noted tendon sheath effusion. Interpretation Image Interpretation: Anterior tibialis tendon thickening with a moderate-sized underlying anechoic fluid collection and marked synovial thickening in the tendon sheath with significant hyperemia about 5cm proximal to its insertion. The Tibiotalar joint was normal. The subtalar joint and talonavicular joints were normal. Impression: Synovial thickening and effusion of the left anterior tibialis tendon sheath without significant tendinosis Teaching Pearl: The tibialis anterior is the primary ankle dorsiflexor, and tibialis anterior tendon pathology may arise from repetitive activity, footwear pressure, trauma, nearby arthritis, diabetes, or degenerative tendon change. Ultrasound findings of tenosynovitis include tendon sheath fluid, synovial thickening, and Doppler hyperemia, with tendinopathy or partial tearing assessed separately. A careful activity and footwear history can help in the initial evaluation. It's important to scan the tendon through the extensor retinaculum and toward the insertion to identify the mechanical site of irritation and to distinguish tendon sheath disease from ankle joint pathology. References: 1. Varghese A, Bianchi S. Ultrasound of tibialis anterior muscle and tendon: anatomy, technique of examination, normal and pathologic appearance. J Ultrasound. 2014;17(2):113-123. doi:10.1007/s40477-013-0060-7 2. Fessell DP, Jamadar DA, Jacobson JA, et al. Sonography of dorsal ankle and foot abnormalities. AJR Am J Roentgenol. 2003;181(6):1573-1581. doi:10.2214/ajr.181.6.1811573 3. Lee MH, Chung CB, Cho JH, et al. Tibialis anterior tendon and extensor retinaculum: imaging in cadavers and patients with tendon tear. AJR Am J Roentgenol. 2006;187(2):W161-W168. doi:10.2214/AJR.05.0073
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Left Anterior Tibialis Tendon

Labeled Short Axis View of the Left Anterior Tibialis Tendon

Unlabeled Long Axis View of the Left Anterior Tibialis Tendon

Labeled Long Axis View of the Left Anterior Tibialis Tendon

Unlabeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler

Labeled Long Axis View of the Left Anterior Tibialis Tendon with Doppler

#7 - Video

Interpretation

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