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<div>Five types of ankle tendon pathology:</div><div>-Tenosynovitis, paratendinitis, peritendinitis</div><div>-Tendinosis</div><div>-Tears (partial, complete, transvers, longitudinal)</div><div>-Dislocation/subluxation</div><div>-Entrapment</div>
"<img src=""paste-d5ca968f2d569fd504ae7ff8628bef98fcf4f56f.jpg"">""<div>Image of tibialis <span style=""color: rgb(255, 85, 0);"">anterior</span> tendon rupture</div><div><br></div><div><div>Tendon should be jet black but has graying within&nbsp;</div></div>"
<div>Posterior tibialis dysfunction is best though of as a __________ of disorders that cause _____________.</div><div>-Continuom </div><div>-Dysfunction</div>
<div>Predominant manifestations of posterior tibialis dysfunction are ______________ rather than _______________.</div><div>-functional</div><div>-symptomatic</div>
<div>Posterior tibialis dysfuntion primarily impacts what age group and sex? What deformity is typically seen?</div><div>-Middle-aged/elderly female</div><div>-progressive flatfoot deformity +/- pain</div>
"<div><span style=""text-decoration-line: underline;"">Johnson and Strom classification</span></div><div></div><div>Minimal deformity, normal length, medial foot/ankle pain, heel raise test painful BUT NORMAL.</div>"Stage I
"<div><span style=""text-decoration-line: underline;"">Johnson and Strom classification</span></div><div></div><div>Supple flatfoot, tendon is ruptured, +heel raise test, BUT FLEXIBLE HINDFOOT&nbsp;</div>"<div>Stage II</div>
"<div><span style=""text-decoration-line: underline;"">Johnson and Strom classification</span></div><div><span style=""text-decoration-line: underline;""><br></span></div><div></div><div>Rupture/tendon degeneration complete, RIGID FLATFOOT</div>"<div>Stage III</div>
"<div><span style=""text-decoration-line: underline;"">Johnson and Strom classification</span></div><div></div><div>Valgus talar tilt/lateral ankle osteoarthritis</div>"<div>Stage IV</div>
<div>PT tendon disorders are largely ________ &amp; _________ disorders</div><div>ischemic &amp; senescent&nbsp;</div>
<div>The primary area of pathology for tendon failure is at the _______ zones.</div><div>Pulley</div>
<div>The last couple of centimeters of the PTT as it moves past the medial malleolus towards its initial insertion on the navicular lacks a ________ _____________.</div><div>Synovial sheath</div><div></div><div>It has a peritenon.</div>
<div>It is believed that the watershed zone of the PTT is in the _______________.</div><div>Mid-tendon (poorly supplied by blood)</div>
"<div><span style=""text-decoration-line: underline;"">MRI of Normal PT Tendon</span></div><div></div><div>Axial morphology:</div>"<div>Ovoid and smooth</div>
"<div><span style=""text-decoration-line: underline;"">MRI of Normal PT Tendon</span></div><div></div><div>PTTD size:</div>"<div>about 2x the axial diameter of the adjacent FDL</div>
"<div><span style=""text-decoration-line: underline;"">MRI of Normal PT Tendon</span></div><div></div><div>At the turn of the ankle, the anterior tibial tendon is slightly __________ than the PTT</div>"larger
"<div><span style=""text-decoration-line: underline;"">MRI of Normal PT Tendon</span></div><div></div><div>Signal:&nbsp;</div>"<div>Black at all pulse sequences, EXCEPT AT ITS INSERTION (DIVIDES INTO SLIPS)&nbsp;</div>
"<img src=""paste-875d574a9ae621490ddd66b73e20b38d7b55f6fb.jpg""><br>A ="Normal&nbsp;
"<img src=""paste-875d574a9ae621490ddd66b73e20b38d7b55f6fb.jpg""><br><br>B=&nbsp;"Paratenonitis
"<img src=""paste-875d574a9ae621490ddd66b73e20b38d7b55f6fb.jpg""><br>C=&nbsp;"Tendinosis
"<img src=""paste-2594ab9345ef9838578b76d58602aff5fe8bf6c8.jpg""><br><br>D=&nbsp;"Partial tears&nbsp;
"<img src=""paste-875d574a9ae621490ddd66b73e20b38d7b55f6fb.jpg""><br><br>E="Total rupture
T/F A small amount of synovial fluid in the PT tendon sheath is abnormalF<br><br>A amall amount is normal
Synovial sheath of PT tendon is normally &lt;___mm and virtually never _______.-2<br>-circumfrential
If synovial sheath of PT tendon is greater than 2mm or circumferential, this equals _________.Synovitis
When a synovial sheath is present in the distal 1-2 cm of the PT tendon, this is related to _________ _________.Metaplastic synovium
Partially circumfrential tendon sheath with distal fluid =Paratendinitis (like achilles)
SYNOVITIS EXISTS WHERE THERE IS A _________________.TRUE SHEATH<br><br>all caps = yelling!
"<img src=""Screenshot 2024-02-29 at 7.24.38 PM.png""><br><br>What does the image on the left show?""Paratendinitis&nbsp;<br><br><span style=""background-color: rgb(170, 0, 0);"">We cannot call it tenosynovitis because we are at the level of the ankle where there isn't a true sheath.</span><br><span style=""background-color: rgb(255, 255, 255);""><br></span><span style=""color: rgb(255, 85, 0);"">I know. I hate this class, too.</span>"
"<img src=""Screenshot 2024-02-29 at 7.30.09 PM.png""><br><br>Can we call this tenosynovitis? Why or why not?""Yes, because at this point the PTT is behind the medial malleolus and is therefore within the synovial sheath.&nbsp;<br><br><span style=""color: rgb(255, 85, 0);"">Did&nbsp;I&nbsp;mention&nbsp;I&nbsp;hate&nbsp;this&nbsp;class?</span>"
What differentiates tendinosis from tendinitis?"<span style=""color: rgb(255, 255, 255);"">No&nbsp;inflammatory&nbsp;component</span>"
Histoly of tendinosis"-<span style=""background-color: rgb(170, 0, 0);"">No acute inflammatory cells</span><br>-intratendinous <span style=""color: rgb(255, 85, 0);"">collagen degeneration</span><br>-Local necrosis<br>-hypocellularity<br>-calcification"
"<img src=""Screenshot 2024-02-29 at 7.40.23 PM.png"">"Big as fuck PTT = tendinosis
"<img src=""Screenshot 2024-02-29 at 7.45.32 PM.png"">""<img src=""Screenshot 2024-02-29 at 7.46.24 PM.png"">"
"<u>PT Tear Classification</u><br><br>Hypertrophic tear pattern<br>-Tendon <span style=""background-color: rgb(170, 0, 0);"">thickened</span>, with <span style=""background-color: rgb(170, 0, 0);"">longitudinal tears&nbsp;</span>"Type I
"<u>PT Tear Classification<br></u><br><span style=""background-color: rgb(170, 0, 0);"">Atrophic tear</span>, with <span style=""background-color: rgb(170, 0, 0);"">markedly attenuated</span> tendon<br>- Equal/smaller than FDL tendon"Type II
<u>PT Tear Classification<br></u><br>Complete tear with discontinuityType III
Per Conti, Type I patients are typicaly symptomatic for how long?&lt;1 year
Per Conti, Type II patients typically symptomatic for how long?1-2 years
In type II chronic PT rupture, tendon is often _________ distal to the tear.enlarged
T/F In type II PT rupture, the tendon shortens&nbsp;FALSE<br>it lengthens
In type I images, we will see foci of increased signal intensity on ____/_____ images.T1/PD
In Type I ruptures, we see tendon thickening secondary to ______, _______ and _______ in its substance.Edema<br>Scarring<br>Hemorrhage
We will see marked _______ in type I ruptures."-enlargement<br><br><span style=""color: rgb(255, 85, 0);"">often 5 to 10 times larger than FDL</span>"
In type I ruptures, we see loss of ________ shape.Ovoid
What is the severity of clinical symptoms for type I ruptures and for how long do they last?Mild<br>6-12 months
"<img src=""Screenshot 2024-02-29 at 8.00.27 PM.png"">"Type 1 tear
"<img src=""Screenshot 2024-02-29 at 8.04.01 PM.png"">""Type I rupture<br><br><span style=""background-color: rgb(170, 0, 0);"">Notice the increased SI in foci</span>"
"<img src=""Screenshot 2024-02-29 at 8.06.13 PM.png"">"Type 1 rupture. Note the longitudinal split.&nbsp;
"<img src=""Screenshot 2024-02-29 at 8.07.34 PM.png"">"Type I rupture.<br><br>Longitudinal splits
"<img src=""Screenshot 2024-02-29 at 8.09.38 PM.png""><br><br>Yellow arrow indicates________.""Type II rupture<br><br><span style=""background-color: rgb(170, 0, 0);"">Notice the PT is smaller than the FDL. Should never be smaller.</span>"
"<img src=""Screenshot 2024-02-29 at 8.11.45 PM.png"">"Type III<br><br>There should be a jet black tendon but there is none. So a full rupture!
The magic angle effect is commin in _________ tendons.Ankle
"<span style=""background-color: rgb(170, 0, 0);"">Spurious increased signal</span> in tissues with <span style=""background-color: rgb(170, 0, 0);"">highly structured collagen fibers</span> defines what?"Magic Angle Effect&nbsp;
Magic Angle Effect occurs when fibers are oriented at _____ degrees to the main field.55
Magic Angle Effect occurs in sequences with ___________ (short or long?) TE.&nbsp;Short<br><br>
The _______ ________ tendon is ESPECIALLY SUSCEPTIBLE to Magic Angle Effect.<br><br>Hint: What's this lecture about?Tibialis Posterior&nbsp;
Magic Angle Effect can be minimized with _____ degrees of ankle ______flexion.-20 degrees<br>-plantar&nbsp;