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Dr Davis Tenosynovitis of FHL on MRI REport Findings

Posted by Alex Prato on 5/01/04 at 15:38 (149878)

Dr DAvis,

Quick synopsis-7 month pain of inner ankle area no numbness, tingling, just consatant pain in inner ankle. Mri Showed Tenosynovitis of FHL&FDL TEndons. Had nerve test NCV showed minimal irritation to post tibial nerve.
TRied, orthoitcs,nsaids, 2 coretisone injections, ice, heat immobilization casting,PT, chiropractic with no success. My physician wants to do a tarsal tunnel release and tenosynovectomy at a success rate of only 50%. I am at wits end.

This is in response to your question on a previous post , you asked about what the tendons look like on MRI. Here is the Findings.

FINDINGS: There is fluid signal intensisty surrounding the flexor hallucis and flexor digitorum tendons consistent with tenosynovitis. This is more pronounced surrounding the FHL tendon and there may be a septation associated with it. No tear of the tendon is identified. The surrounding muscles are normal in signal intensity and morphology. The extensor tendons appear intact. The PCT appears intact. There is normal fatty signal intensity seen within the sinus tarsi. The achilles is intact. The anterior and posterior talofibular ligamants are intact.

IMPRESSION: TEnosynovitis of the FHL And FDL more prounounced of the FHL and there is a septation within the fluid.

Dr DAvis.-- What is the significance of the septation within the fluid?

Also could this problem i have go away on its own or will i have to live with it? Could the surgery make it worse? What would you do in my situation? I thank you for your advice.

Re: Dr Davis Tenosynovitis of FHL on MRI REport Findings

Ed Davis, DPM on 5/01/04 at 21:41 (149888)

Alex:
Unsure about the significance of 'septation' within the fluid other than that may represent an area of scar tissue that 'walls off' some of the fluid so that the fluid is not in one continuous area of flow. More specifically, I would be interested in knowing more about the precise location of the fluid, either via a report or by looking at the MRI itself. The flexor retinaculum is the area on the inside of the ankle than contain separate compartments for the structures discussed: sometimes remembered by students as 'Tom, Dick and Harry'...
Tom: Tibialis posterior tendon
Dick: flexor Digitorum longus tendon
And: Artery nerve and vein -- the compartment where the post. tibial artery, associated veins (2) and posterior tibial nerve runs.
Harry: flexor Hallucis longus
The order of depth is consistent with the Tom, Dick and Harry 'pneumonic' in that Harry, ie. flexor hallucis longus is the deepest structure. Swelling of Flexor hallucis longus is less likely to place pressure on the nerve than swelling of tibialis posterior. We need to look carefully at that specific area.
Ed

Re: Dr Davis Tenosynovitis of FHL on MRI REport Findings

Alex Prato on 5/02/04 at 16:40 (149908)

Dr DAvis,

Thanks for the response, i appreciate it. Can this get better on its own and would you think surgery would be an invitation to problems? I 've had this for 8 months.

Re: Dr Davis Tenosynovitis of FHL on MRI REport Findings

Ed Davis, DPM on 5/04/04 at 22:48 (150056)

Alex:
It is a bit of a tough call without seeing the actual MRI films. Also, I would like to know that the orhtotics treid had the two features I had mentioned -- a Kirby skive and a first ray cut out.
Ed