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IMAGING FOR RESIDENTS QUIZ Table of Contents  
Ahead of print publication
A triathlete with lateral retromalleolar pain


1 Department of Family Medicine, Université de Montréal, Montreal, Canada
2 Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada

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Date of Submission28-Mar-2021
Date of Decision20-Apr-2021
Date of Acceptance28-Apr-2021
Date of Web Publication29-Jul-2021
 


How to cite this URL:
Giroux E, Lamontagne M, Boudier-Revéret M. A triathlete with lateral retromalleolar pain. J Med Ultrasound [Epub ahead of print] [cited 2021 Oct 26]. Available from: http://www.jmuonline.org/preprintarticle.asp?id=322286





  Section 1 – Quiz Top


A 47-year-old triathlete with pain in his lateral left ankle was referred for a musculoskeletal ultrasound evaluation. He had no past medical history. Eighteen months prior to consultation, he had a sudden onset of sharp pain in the retromalleolar area while climbing a hurdle during an obstacle race. No swelling was noted. Physiotherapy and foot orthosis did not help. He was not able to resume running. Twelve months after the injury, a magnetic resonance imaging (MRI) revealed mild tendinopathy and tenosynovitis of the fibular tendons and lateral malleolus bone marrow edema. A corticosteroid injection of the fibular sheath done under ultrasound guidance was performed and did not help him. Upon review of the MRI imaging, there was a suspicion of longitudinal split tear of the fibular brevis tendon and a retinaculum tear.

On physical examination, he had bilateral pes cavus. There was no swelling or atrophy in the ankle region. Gait and ankle range of motion (ROM) were normal. Tiptoeing and jumping reproduced his left lateral ankle pain. He did not have pain on isometric testing of the fibular brevis tendon and mild discomfort on isometric testing of the fibular longus tendon. He had mild pain upon palpation of the retromalleolar area, as well as at the attachment of the fibular retinaculum on the posterolateral malleolus. There was a doubt regarding possible subluxation of the fibular tendons with resisted active eversion.

Static and dynamic ultrasound (Philips Epiq 5, 7–18 MHz multifrequency linear probe) of the fibular tendons was performed [Video 1]. The readers should analyze [Figure 1] and [Figure 2] and Video 1 to define all the abnormal findings.
Figure 1: Ultrasound view of the lateral ankle at rest

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Figure 2: Ultrasound view of the actively everted lateral ankle

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  What is your diagnosis? Top


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



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Correspondence Address:
Mathieu Boudier-Revéret,
Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, 3840 St. Urbain St., Montreal, QC, H2W 1T8
Canada
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Source of Support: None, Conflict of Interest: None



    Figures

  [Figure 1], [Figure 2]



 

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