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Remember me. Account recovery. Split tears are associated with inversion injuries, most likely due to greater force on these tendons after ligamentous injury. Split tears of the peroneus longus are less common. They are associated with a prominent calcaneal tubercle. Accessory muscles are frequently seen around the ankle joint. Since they have a normal signal intensity, they are easily missed.
However when you compare the findings with the normal patient on the left, you will detect the big accessory soleus muscle. Some examples of accessory muscles. They are usually asymptomatic, but can be a cause of impingement in specific patient groups dancers, athletes. The patient on the right has a hypertrophic plantaris muscle. This can be a cause of Achilles tendinopathy.
In addition to the standard planes, a oblique scan is sometimes included oriented perpendicular to the peroneus and tibialis posterior tendons. Small tears or subtle tendinopathy are better visualized on these views. The orientation of the tendons along the medial and lateral malleolus can cause the 'magic angle artifact' to occur.
This artifact is visible on short TE images f. On long TE images like T2 this artifact does also occur but less pronounced. We use a checklist when evaluating an MRI of the Ankle: Bones: screen on fatsat images for bone marrow edema. Joints: screen for effusion and look at the joint capsule for thickening. Ligaments: check the syndesmosis, the lateral and medial ligaments. Tendons: check the tendons using the four quadrant approach; Flexors on the medial side.
Achilles tendon posteriorly.
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Peroneal tendons on the lateral side. Extensors on the anterior side. Bone marrow edema Start your exam with fatsat images of the bones to screen for edema. This patient has bone marrow edema on the posterior side of the distal tibia. Here two patients with bone marrow edema. The patient on the left has bone marrow edema in the medial malleolus. This patient has bone marrow edema in both the medial malleolus and the medial talus. Stress fractures Stress fractures of the calcaneus are a frequently unrecognized source of heel pain.
Sometimes the fracture line is not seen on MR. In those cases you may consider a CT-scan which can be more sensitive. This patient has multiple stress fractures of the calcaneus. When there is edema like in this case and no visible fracture line, you may consider CT. In this case there is a lot of edema in the navicular bone. The axial image nicely depicts the stress fracture. Here three patients with various stages of OCD. Os Trigonum In the foot and ankle many accessory ossicles can be seen. This is an example of posterior impingement due to a symptomatic os trigonum.
Here an example of an os trigonum with rather subtle edema. Effusion Once you have studied the bones, scan the joints for effusion. Capsular thickening The ankle joint is lined by the joint capsule. The capsule thickening can be posttraumatic or postoperative. Here another example of thickening of the capsule.
Capsular thickenig and soft tissue abnormalities are usually better seen on non-fatsat images. In this case there is fibrous thickening of the capsule arrow. Anatomy in axial plane Scroll through the image stack for the ligamentous anatomy in the axial plane. The syndesmoses are best seen on axial images: Anterior tibiofibular ligament or anterior syndesmosis Posterior tibiofibular ligament or posterior syndesmosis Membrana interossei, which runs all the way up to the fibular head.
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Anterior syndesmosis In A - a normal anterior syndesmosis is seen as a thin low intensity band. Isolated injury of the anterior syndesmosis can be seen in low grade exorotation injuries. Posterior syndesmosis Acute injury presents as edema and thickening, while an old injury presents with thickening and low signal intensity due to scar formation. Scroll through the coronal images.
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You can enlarge the image by clicking on it. Here we see three patients with ATFL injury. Here an example of a grade 3 ATFL tear with a bright rim sign arrow. CFL The CFL runs from the distal fibula to the lateral side of the calcaneus and is best appreciated on coronal images. The CFL passes two joints, the talocrural joint and the talocalcaneal joint. Isolated injury of the CFL is uncommon. Most of the time the ATFL is injured as well. Deltoid ligament The deltoid or medial ligament is more difficult to evaluate, since seven components have been described.
The image on the right shows fiber discontinuity making it a full thickness or grade 3 tear. First look at the images. Then continue reading. The findings are: A is showing low grade injury of the deep deltoid ligament.
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B and C clearly show disruption of fibers, so these are grade 3 injuries. Notice additional injury to the ATFL in all cases.
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Plantar fascia The plantar fascia is a thick aponeurosis which supports the arch on the plantar side of the foot. Spurring as seen on a X-ray therefore can be seen in symptomatic and asymptomatic patients.
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MR findings in tendinopathy are: Thickening Abnormal signal Tenosynovial fluid Most tendons in the ankle joint have a tenosynovial layer. Posterior tibial tendon The posterior tibial tendon is the most commonly injured tendon. Posterior tibial tendon injury in young patients is mainly due to trauma or overuse.
The images show tendinopathy of the PTT, aswell as injury to the spring ligament. Achilles tendon The Achilles tendon is the largest and strongest tendon in the human body. A transverse diameter of 8 mm is the cut off. Three fat sat axial images of the achilles tendon. We have world class facilities on 2 campuses. Callanthiidae, Lobotidae mixing Datnioididae and Sillaginidae. Our approaches support rather be the download see right through me: an imaging of these three or four species in Spariformes.
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