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Peroneal Tear confirmed via MRI

 

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thirstygreek

Oct 22, 10 15:58

Post #1 of 38 (9203 views)
Peroneal Tear confirmed via MRI Quote | Reply

Just got a quick verbal report on my MRI I had yesterday on my L ankle confirming what I think he said was split tear in my peroneal brevis tendon. I will talk to the ortho who ordered the MRI on Monday but from all of my research it appears surgery is the most effective way to deal with this.

Guess its a good time of year to have surgery but I may have to put my half marathon off that is in February.

RROOF? any thoughts? I am in MA so if there are any well known sports centric surgeons I should seek a 2nd from please advise.

Thanks!


squesen

Oct 22, 10 16:57

Post #2 of 38 (9176 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Is it torn all the way through?

I have an 8mm tear in an ankle tendon at the moment. I am treating it with nitroglycerin patches and aggressive PT including ultrasound and lots of stretching/strengthening. I might consider a platelet concentrate injection if the nitro doesn't do it for me.

Tendons can heal -- it takes time. Nitro is supposed to improve blood flow to the area and help healing. But if it's torn through, you're sunk.

Either way, sorry to hear this. I know first hand how bad it sucks. I found out about mine 6-weeks out from an IM and had to drop out of the race. :(


kbrunner

Oct 22, 10 17:17

Post #3 of 38 (9163 views)
Re: Peroneal Tear confirmed via MRI [squesen] [In reply to] Quote | Reply

I havew used the Nitro patches and they do work!


LuckyMe

Oct 22, 10 17:26

Post #4 of 38 (9154 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

I first read that as "Perineal Tear" and thought really bad thoughts.



rroof

Oct 22, 10 18:12

Post #5 of 38 (9126 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Depends on the size of the tear if surgery is warranted. Just repaired one Thurs (4.2cm long). Fixed her other side 4 years ago! My very rough rule of thumb is that a longitudinal peroneus brevis (mostly commonly, occasionally the longus) tear less than 2.5 cm (about an inch), I cast/immobilize, then PT. Tears larger than 2.5 cm - primary repair (and usually augmentation with Pegasus, graft jacket, etc.). Threshold for surgery varies for a variety of reasons, with most on this board leaning closer to surgical repair. Best of luck! PM sent as well.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


Jodi

Oct 22, 10 18:41

Post #6 of 38 (9107 views)
Re: Peroneal Tear confirmed via MRI [LuckyMe] [In reply to] Quote | Reply

In Reply To:
I first read that as "Perineal Tear" and thought really bad thoughts.

x2...

Jodi


thirstygreek

Oct 22, 10 19:33

Post #7 of 38 (9074 views)
Re: Peroneal Tear confirmed via MRI [Jodi] [In reply to] Quote | Reply

Appreciate the advice! I will know more Monday. I would like to try the immobilize and PT but only if there is a high chance of recovery. I will also suggest the nitro patches as well. Anything to increase blood flow.

Are plasma injections covered by most HMOs?

rroof PM sent, thank you.


LoDewey

Oct 22, 10 19:34

Post #8 of 38 (9074 views)
Re: Peroneal Tear confirmed via MRI [Jodi] [In reply to] Quote | Reply

In Reply To:
In Reply To:
I first read that as "Perineal Tear" and thought really bad thoughts.

x2...

Jodi
X3. That's the only reason I opened the thread!


(This post was edited by LoDewey on Oct 22, 10 19:34)


thirstygreek

Oct 22, 10 19:39

Post #9 of 38 (9067 views)
Re: Peroneal Tear confirmed via MRI [LoDewey] [In reply to] Quote | Reply

seemed like it was getting a lot of views for a thread on a tendon


thirstygreek

Oct 25, 10 10:28

Post #10 of 38 (8958 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Got a call from the ortho today, he didn't mention size of the tear but he recomends surgery. He mentioned due to the fact I am an active person this would be this best route. He said I could bear weight on the "cast" just not at first. I would like more details. He does operate out of New England Baptist which was good news. I am just not keen on anesthesia but I don't know if just going with the nerve block is a smart idea...6-8 week Pwb/wbat will be tough, maybe he will be open to active recovery.


thirstygreek

Oct 25, 10 13:52

Post #11 of 38 (8884 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Bump


Devinci

Oct 25, 10 14:41

Post #12 of 38 (8856 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Slightly ahead of you with the tear. My tendon was torn into three sections. Had surgery back on Sept 17th and will have the cast off Nov 3. I was told to keep weight off and have. Anxious for next appointment to see how it is progressing and if I will be able to start to put weight on it.
Devinci


rroof

Oct 25, 10 15:15

Post #13 of 38 (8829 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Platelet rich plasma injections (and or entities like Nitro patches) are not going to help much in a high grade longitudinal tear of the tendon. They are best utilized for chronic cases/tendinosis. Speedy healing. Don't fret the anesthesia - I can repair these with IV sedation/local field block, but other surgeons prefer general anesthesia. Most anesthesia people do poor ankle blocks though, but are super skilled intubators!
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


thirstygreek

Oct 25, 10 16:17

Post #14 of 38 (8807 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

Do you follow the 2 week nwb protocol as well? I have read I may be able to get on the trainer as soon as 2-3 weeks post op


rroof

Oct 25, 10 16:44

Post #15 of 38 (8792 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

In Reply To:
Do you follow the 2 week nwb protocol as well? I have read I may be able to get on the trainer as soon as 2-3 weeks post op


For the most part, yes. Depends on several factors: patient trust (triathletes are a HUGE red flag!), how big the tear was, how old and was there mucinous degradation or significant tendon debridement, whether a graft was used, etc. Don't rush your recovery as tendons heal slow, but the "surgery" will appear to be good to go way before the slow healing peroneal tenodn is. Listen to your surgeon and follow his and your therapists (likely) instructions carefully.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


xrayclyde

Oct 25, 10 17:58

Post #16 of 38 (8742 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

Could a Peroneal Tear be diagnosed with ultrasound? My longus and brevis seem to be bothering me for about two years. It feels more like an ankle sprain with point tenderness just distal to the lateral malleolus. ART helped releasing it, but it comes right back.


thirstygreek

Oct 25, 10 18:15

Post #17 of 38 (8729 views)
Re: Peroneal Tear confirmed via MRI [regis] [In reply to] Quote | Reply

Thanks rroof ! Going to be 2 weeks before procedure because I dont want to be on crutches in NYC when I am rooting for my wife at the marathon


rroof

Oct 25, 10 18:18

Post #18 of 38 (8722 views)
Re: Peroneal Tear confirmed via MRI [regis] [In reply to] Quote | Reply

In Reply To:
Could a Peroneal Tear be diagnosed with ultrasound? My longus and brevis seem to be bothering me for about two years. It feels more like an ankle sprain with point tenderness just distal to the lateral malleolus. ART helped releasing it, but it comes right back.


Yes, diagnostic ultrasound is a decent imaging modality for tendon pathologies, esp the peroneals, but is very operator dependent. The more common injury would be the peroneus brevis (esp with a 2 year history) that lies deep to the longus. Point tenderness is generally from right behind to inferior of the lateral malleolus or with resisted eversion. Some subtle localized edema is usually noted. An MRI shows far greater detail though which can be important in deciding between treatment options (i.e. surgery). Had a very small, 1.5cm tear just today in a very overweight, sedentary 24 year old female for example on MRI - definitely not a surgical candidate. 2 weeks ago, a 4cm tear in the brevis in an active runner - quite the opposite, although the symptoms/clinical exam were almost identical.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


xrayclyde

Oct 25, 10 19:45

Post #19 of 38 (8701 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

Is there anyone in Indianapolis you would recommend to help with this? I think you are two hours away.


thirstygreek

Nov 21, 10 13:36

Post #20 of 38 (8567 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

rroof,

thanks for the advice and time...it has been a while and I had the MRI and the surgeon said "well you are athletic so I think surgery is the best option" It was very quick and I went along but surgery is still 3 weeks away!

Since the MRI I obviously have ceased all running and have kept up swimming and some light spinning as it causes no discomfort. The problem is for the past almost three weeks I have had NO pain, I occasional feel a little twinge of like pressure right at the lateral malleous but its not pain and its rare. Last week I was shooting hoops with my 13yo at the gym to warm up for a weight training session and before I knew it I was going all out 100% jumping shooting etc with ZERO pain. I did this twice. What this has me thinking is, has the tendon begun to heal? Is it possible on its own? I am a vegan who eats very well and generally heal rapidly and recover from workouts quickly (I know anecdotal)

I misplaced the MRI reading which I will find but it read split tear of peroneal longus and then its specified from where to where...I have linked to an album with images from the MRI, if you have a sec can you look? I am contemplating a second opinion but I need to find someone who works with athletes.

http://picasaweb.google.com/thirstygreek/Misc#

Thanks a ton


rroof

Nov 21, 10 13:52

Post #21 of 38 (8558 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

Couple of things: I find that vegans heel SLOWER than not, on avg (just some FYI). Sure, it could have healed (but not in 3 weeks). Again, depends on the size of the tear (among other factors) on whether I would rec surg. You saw someone and he did, so for now, stay with the only person qualified to give you a real answer! Now, nothing wrong with another opinion of course.

edit: just saw your posted MRI. You do have some peroneal thickening/fibrosis just behind the lateral malleolus, but you only have about 3 sagittal images there showing the peoroneal(s) (really need to see the whole exam, T1/T2 weighted images, etc.) to really get some more info.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

(This post was edited by rroof on Nov 21, 10 13:56)


thirstygreek

Nov 21, 10 13:55

Post #22 of 38 (8553 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

Ok thanks, my 'evidence' of faster healing is based on my faster recovery since turning vegan as opposed to prior years, nothing more.

As for the images does the tear look large?


rroof

Nov 21, 10 16:42

Post #23 of 38 (8510 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

In Reply To:
Ok thanks, my 'evidence' of faster healing is based on my faster recovery since turning vegan as opposed to prior years, nothing more.

As for the images does the tear look large?

I really can't tell the size (first on my iPhone, now laptop) from just 3 sagittal T1 images since the brevis and longus (and occasionally tertius) run together and can be misdiagnosed as a tear.

From what I can see, no - looks small/chronic. Much like a rotator cuff tear/injury in the shoulder, you can function at a pretty high level though, despite the tear. Does that mean you need surgery? Again, for you to discuss with your surgeon.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


thirstygreek

Nov 21, 10 16:57

Post #24 of 38 (8499 views)
Re: Peroneal Tear confirmed via MRI [rroof] [In reply to] Quote | Reply

thanks rroof, I am seeking an appointment with a foot ankle guy at MGH


rilesgregb

Apr 16, 13 13:40

Post #25 of 38 (5256 views)
Re: Peroneal Tear confirmed via MRI [thirstygreek] [In reply to] Quote | Reply

So just now reading this as I am having an MRI today for peroneal trouble. Curious as to how this turned out. Did you have the surgery? Was it successful? How long was recovery?

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Winter stationary bike training
Will you use a stationary trainer this winter, is it a smart (e.g., Kickr, Computrainer) or a dumb (typical mag or fluid) trainer, and do you already own it?
Smart, have it
Smart, intend to buy it
Dumb, have it
Dumb, intend to buy it
Won't be riding on a trainer