Interactive Transcript
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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
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fibula, and we're looking at the peroneus complex.
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Who's who, what's what?
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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.
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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
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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.
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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.
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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
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the lateral retinaculum all in one felt swoop.
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