Tibialis Anterior Tenosynovitis

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Tibialis Anterior Tenosynovitis

Authors, Editors, Case Information Author: David Ross, MD Affiliation: Ross Medical Group, Miami, Florida Co Author(s): Mehak Sharma, MD. Department of Internal Medicine, FIU Herbert Wertheim College of Medicine, Bruce W. Carter VA Medical Center, Miami, Florida. Jackson Memorial Hospital, Miami, Florida. Senior Editor: William Berrigan, MD Clinical Vignette: A 69-year-old man presented with acute left ankle pain following a hiking trip in the mountains. He walked up and downhill in flat boat shoes for several hours. On awakening the next day, he noticed swelling in the anterior aspect of his ankle along with severe pain with predominantly dorsiflexion of his ankle. Physical examination in the Sports Medicine office revealed bilateral pes planus. There was limited left plantarflexion and dorsiflexion with both active and passive range of motion. Left sided limitation in active and passive dorsiflexion was noted. He had 5/5 strength with ankle plantarflexion and dorsiflexion, and severe pain with resisted ankle dorsiflexion. Type of Probe Used: 8-12 MHz Linear Transducer Unlabeled Long Axis View of the Tibialis Anterior Tendon Unlabeled Long Axis view of the tibialis anterior tendon. Labeled Long Axis View of the Tibialis Anterior Tendon Labeled Long Axis view of the tibialis anterior tendon demonstrating anechoic fluid surrounding the anterior tibialis tendon along its course, with preserved tendon fibrillar architecture and no evidence of discrete tear or significant tendon thickening. The distal tibia is visualized as an intact hyperechoic bony cortex proximally and deep. Unlabeled Short Axis View of the Tibialis Anterior Tendon Unlabeled Short Axis view of the tibialis anterior tendon. Labeled Short Axis View of the Tibialis Anterior Tendon Labeled Short Axis view of the tibialis anterior tendon demonstrating the anterior tibialis tendon (ovoid structure) surrounded by a hypoechoic to anechoic fluid collection within the tendon sheath, consistent with tenosynovitis. Interpretation Image Interpretation: Tibialis anterior tendon is surrounded by a hypoechoic to anechoic fluid collection within the tendon sheath, consistent with tenosynovitis. The tendon appears ovoid with circumferential fluid tracking along its periphery. Fluid is seen surrounding the tendon along its course, with preserved tendon fibrillar architecture and no evidence of discrete tear or significant tendon thickening. The distal tibia is visualized as an intact hyperechoic bony cortex posteriorly. Teaching Pearl: Tibialis anterior tenosynovitis can be an underrecognized cause of anterior ankle pain in active patients and can be mistaken for ankle osteoarthritis, digit extensor tendon pain, or nonspecific overuse pain. Ultrasound can show fluid within the tendon sheath, synovial thickening, Doppler hyperemia, and preserved or abnormal tendon fibrillar architecture depending on whether tendinopathy is also present. A careful history should include footwear, activity type, and repetitive dorsiflexion loading. 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. Lee JCY, Lui TH. Tendoscopic synovectomy of tibialis anterior tendon of the ankle. Arthrosc Tech. 2018;7(12):e1243-e1248. doi:10.1016/j.eats.2018.08.009 3. Harkin E, Pinzur M, Schiff A. Treatment of acute and chronic tibialis anterior tendon rupture and tendinopathy. Foot Ankle Clin. 2017;22(4):819-831. doi:10.1016/j.fcl.2017.07.009
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Tibialis Anterior Tendon

Labeled Long Axis View of the Tibialis Anterior Tendon

Unlabeled Short Axis View of the Tibialis Anterior Tendon

Labeled Short Axis View of the Tibialis Anterior Tendon

Interpretation

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