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Peroneus Longus and Brevis Tendons Tear

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So we're up high, lower leg, syndesmotic level,

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some of the myotendinous unit coming off the

0:07

fibula, and we're looking at the peroneus complex.

0:12

Who's who, what's what?

0:15

The peroneus brevis, higher up, sits

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a little bit behind the peroneus

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longus, and they switch positions.

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So this is brevis, brevis, brevis, longus,

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with some signal inside, retinaculum, and

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perhaps some stringy little tissue over here.

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That is yet to be defined.

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Let's start scrolling down.

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And as soon as we get a little bit

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further down, our brevis looks horrible.

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It's irregular.

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It's straggly.

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It's ragged.

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And there's another piece of tendon here.

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With a massively distended retinaculum.

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And there's our longus in the

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front with some signal inside.

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Let's keep going, shall we?

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Look at our longus.

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Abnormal.

0:59

Look at our brevis.

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Brevis.

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Brevis.

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Splitting into two.

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Because what has happened is down

1:07

low, the brevis split into two.

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Let me draw it.

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Down low, the brevis split into two.

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The longest was in the middle.

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And as we went up higher, the two torn

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components of the brevis, as we went up,

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slid backwards and sat behind the longest.

1:31

As we go down, you're going to see

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them assume a more anterior position.

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And they are.

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They're more anterior.

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They're starting to come around.

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Here's one limb.

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Here's the other limb.

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They're going to wrap right

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around and go in front.

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Here they, they're going in front.

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They have gone in front.

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There they are together.

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That is the peroneus brevis back together again.

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Now let's go back up.

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Watch it split.

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It's going to drape right around.

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It's draping around the longus,

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which, by the way, is abnormal.

2:00

It's now draped around the back.

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It's going to stay behind

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the longus as we go higher.

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There's the torn brevis.

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Now let's go back down.

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Still, torn brevis, two pieces,

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wrapping around, wrapping around.

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Now it's in the front.

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And there's our sick peroneus longus, which I'm

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going to magnify and make a little bigger so you

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can see the tear in the longus, too, right there.

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And now the longus, in its weak area, where

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it goes into the cuboidal tunnel, has some

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tendinosis affecting it, and it gets quite a

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bit grayer as it goes into the plantar arch.

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And there's one other interesting caveat in

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this case, and that is that the two arms,

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the two torn leaves of the peroneus brevis,

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this one right here, it itself is torn.

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So we have a medial bundle that's torn,

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a lateral bundle that's torn of the P.

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brevis, and within the medial bundle All

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these little gray areas, those are tears.

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So there's a tear in a tear.

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What else can we say about this monstrous case?

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We can say that the retinaculum is stripped

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off the fibula and distended and elastic,

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no longer holding these structures in place.

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Let's check out the groove.

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It's convex backward about 10 or 11

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percent of patients that predisposes

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to peroneus longus and brevis tears.

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So in summary, you're seeing the GOAT.

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The greatest of all time, peroneus brevis tear.

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A tear within a tear.

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The relationship of the brevis to the longus.

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A tear of the longus.

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An injury, a stretch injury and stripping of

3:40

the lateral retinaculum all in one felt swoop.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Trauma

Musculoskeletal (MSK)

MSK

MRI

Foot & Ankle

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