Peroneus Brevis Split Tear

[Ben Crathan]

Hi Steve,

When assessing Peroneus Brevis , I can identify the c – shaped PB tendon as being tendinopathic but have a hard time deciding when it changes from a compression deformation to a longitudinal split tear. Do you have anything specific you look for?

[Stephen Bird]

Hi Ben,

Indeed,

With this type of compressive tendinosis at the apex of the cup shaped tendon it gets thinner and thinner until it eventually splits and becomes 2 peroneus brevis tendons.

This is an easy diagnosis of a longitudinal split, but I will suggest it when I start to see cystic myxoid degeneration forming in this area. Also I do compression testing with transducer pressure and you can sometimes see the split more obviously by the way the tendon moves. When it is split you can move the 2 halves of the tendon separate from each other with transducer pressure.

In the longitudinal plane with tendinosis the tendon will appear like “particle board” rather than linear lines of collagen and when they split you can sometimes see a longitudinal defect like a syrinx running through the tendon.

Basically any time I see some disorganization in the architecture of the tendon and not just simple particle board transformation I will suggest the possibility of a longitudinal split tear.

I apply the same logic to tibialis posterior which loves to split as well.

Cheers,

Steve

[Stephen Bird]

Hi Ben,

I have uploaded an example case of what I would call a split.

Steve

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[Diane]

Hi Steve,

I scanned an old female with general chronic bilateral ankle pain.
When I was scanning the peroneal tendons, I realised the peroneal brevis has a C shape appearance to it. She wasn’t very symptomatic…. Is this what you would call a chronic split tear?

Sometimes I notice this appearance when scanning ankles but am not sure if I’m MSU

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[Stephen Bird]

HiDiane,

This one looks completely split to me !

Looks like it is in 2 parts.

Nice they are not symptomatic,

I wonder if they will have a tenosynovitis flare up from time to time.

I don’t think this is MSU,

I think it is real,

By the way I love your profile pic.

Steve

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