Best Practice Case Studies-Case 112 Asset 4 Fibularis Tendon Tear

Video Transcription

Video Summary

A sports medicine ultrasound case presentation reviews evaluation of a soccer player with insidious, progressively worsening lateral ankle pain and audible snapping/popping, worse with kicking. Exam showed tenderness over the retromalleolar fibular tendons and reproducible snapping with ankle circles; X‑rays were unremarkable.<br /><br />The speaker emphasizes tailoring an ultrasound protocol to the patient while ensuring a complete exam. The scan included a brief look at the anterolateral ankle joint for effusion/impingement and assessment of talar cartilage, followed by key lateral ligaments (ATFL, AITFL with optional stress testing, and CFL), the lateral subtalar joint, and nearby nerves (sural, superficial fibular and branches, and deep fibular), documenting symptom reproduction with sonopalpation.<br /><br />Pathology was found in the retromalleolar groove: fibularis longus appeared normal, while fibularis brevis showed a crescent/horseshoe deformation consistent with an early longitudinal split tear. Dynamic imaging demonstrated intrasheath subluxation (tendons “snapping” around each other) with an intact but thickened superior peroneal retinaculum; tendons remained posterior to the malleolus. Discussion highlights that split tears can be subtle and benefit from proximal-to-distal and distal-to-proximal sweeps, and reminds clinicians to assess lateral cord plantar fascia at the base of the fifth metatarsal.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 2

Topic Ankle

Keywords

4th Edition

4th Edition, Case 2

Ankle

sports medicine ultrasound

lateral ankle pain

peroneal tendon snapping syndrome

fibularis brevis longitudinal split tear

intrasheath subluxation

superior peroneal retinaculum thickening

dynamic ankle ultrasound protocol