What’s the Diagnosis – Case 167
1
What’s the Diagnosis – Case 167
2
What’s the Diagnosis – Case 167
3
What’s the Diagnosis – Case 167
4
What’s the Diagnosis – Case 167
5
What’s the Diagnosis – Case 167
6
What’s the Diagnosis – Case 167
7
What’s the Diagnosis – Case 167
8
What’s the Diagnosis – Case 167
9
What’s the Diagnosis – Case 167
10
What’s the Diagnosis – Case 167
11
What’s the Diagnosis – Case 167
12
What’s the Diagnosis – Case 167
13
What’s the Diagnosis – Case 167
14
What’s the Diagnosis – Case 167
15
What’s the Diagnosis – Case 167
16
What’s the Diagnosis – Case 167
17
What’s the Diagnosis – Case 167
18
What’s the Diagnosis – Case 167
19
What’s the Diagnosis – Case 167
20
What’s the Diagnosis – Case 167
21
What’s the Diagnosis – Case 167
22
What’s the Diagnosis – Case 167
23
What’s the Diagnosis – Case 167
24
What’s the Diagnosis – Case 167
25
What’s the Diagnosis – Case 167
26
What’s the Diagnosis – Case 167
27
What’s the Diagnosis – Case 167
28
What’s the Diagnosis – Case 167
29
What’s the Diagnosis – Case 167
30
What’s the Diagnosis – Case 167
31
What’s the Diagnosis – Case 167
32
What’s the Diagnosis – Case 167
33
What’s the Diagnosis – Case 167
34
What’s the Diagnosis – Case 167
35
What’s the Diagnosis – Case 167
36
What’s the Diagnosis – Case 167
37
What’s the Diagnosis – Case 167
38
Findings The radiographs do not show any abnormality. On the MRI, there is a lateral displacement of the peroneus longus (positioned lateral to the fibula instead of orthotopic position posterior to the fibula within the peroneal/retromalleolar groove) with a stripping and scarring of the superior peroneal retinaculum (SPR). The peroneus brevis (P. Brevis) is hyperintense and tendinotic.
What’s the Diagnosis – Case 167
39
What’s the Diagnosis – Case 167
40
What’s the Diagnosis – Case 167
41
What’s the Diagnosis – Case 167
42
What’s the Diagnosis – Case 167
43
What’s the Diagnosis – Case 167
44
What’s the Diagnosis – Case 167
45
What’s the Diagnosis – Case 167
46
What’s the Diagnosis – Case 167
47
What’s the Diagnosis – Case 167
48
What’s the Diagnosis – Case 167
49
What’s the Diagnosis – Case 167
50
What’s the Diagnosis – Case 167
51
What’s the Diagnosis – Case 167
52
What’s the Diagnosis – Case 167
53
What’s the Diagnosis – Case 167
54
What’s the Diagnosis – Case 167
55
What’s the Diagnosis – Case 167
56
What’s the Diagnosis – Case 167
57
What’s the Diagnosis – Case 167
58
Diagnosis: Peroneal Dislocation (with stripping of the superior peroneal retinaculum) The superior peroneal retinaculum is a band of tissue/fascia that extends from the distal, lateral fibula to the Achilles and calcaneus. It is the main restraint to holding the peroneal tendons in place. Injury of the retinaculum allows a subluxation or dislocation of the peroneus longus. Most commonly, as in this case, there is a stripping of the peroneal retinaculum forming a small pocket that allows the longus to insinuate into it. The Ogden classification is most commonly employed for SPR injury and conveys stripping, tearing of the SPR at the fibula, avulsion fracture at the fibula attachment, or posterior disruption. Conservative measures can be tried but surgery with repair of the SPR as well as a deepening of the peroneal or retromalleolar groove of the fibula is often needed.
What’s the Diagnosis – Case 167
59
References MRI Features of Chronic Injuries ofthe Superior Peroneal Retinaculum. Zehava Sadka Rosenberg, Jenny Bencardino, Donna Astion,Mark E. Schweitzer, Andrew Rokito, Steven Sheskier. AJR 2003;181:1551–1557.
What’s the Diagnosis – Case 167
60