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These are the terms that I use when describing various

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pathologies involving the tendons, the ankle and foot.

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I would agree that there is controversy about some

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of these terms and they are not used

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consistently in the literature.

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I always turn to the English dictionary when trying

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to come up with proper terms.

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If you go to the English dictionary, the term para, PARA,

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means near or next to it, is not the same as the term per

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Perry means around or surrounding.

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So with that in mind, with those well-known definitions,

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these are the terms that I use.

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Tino synovitis comes in two types.

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I'll show you in a in a minute or two.

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It's inflammation of a tend sheet.

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Parat synovitis represents inflammation of tissues

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around a tendon that has a sheet.

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Para tendonitis relates to inflammation

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of tissues about a tendon peritonitis,

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not peritonitis.

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Peritonitis is inflammation of a perin,

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tendinosis the term.

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Some people say tendinopathy relates to tendon degeneration,

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and we use that term throughout the body when we talk about

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abnormal tendons.

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Let's look at some examples.

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This is Achilles peritonitis.

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Now it may not look like much, but if you have it

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or one of your patients has it,

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these people can have in fact, extensive pain.

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This is what it looks like on a sagittal image,

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and this is the classic appearance on an axial image.

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So classically, not invariably, it is U-shaped

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without covering the anor aspect of the Achilles

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hara, not peri.

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And in some cases, it'll have vertical limbs

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that extend into the pre Achilles fat bed.

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Now, in rare cases, there will be an anterior component,

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hence Achilles peritonitis.

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But in most cases, para tendonitis is the proper term.

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This is Achilles perro tendonitis.

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It is inflammation involving a portion of the pre Achilles,

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uh, fat pad, typically seen along the lower portion

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of the Achilles tendon.

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Now, sometimes you see non-specific edema within this fat

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pad, alright, but if in fact

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that edema is located centrally in front

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of the Achilles tendon between these pontic fibers,

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it is often symptomatic.

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It almost looks like fat

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Pad impingement occurring in that area.

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You see this most frequently in runners

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10 synovitis is inflammation of a tend sheet.

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It comes in two forms.

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Regular teno synovitis shown here, used

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to drive inflammation in the tendon sheet

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and what is called S stenosing, teno synovitis, sometimes

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teno vaginitis.

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It describes inflammation with adhesions

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between the tendon sheet

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and the tendon restricting tendon motion.

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This is a more significant finding than this

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to show you two examples of S stenosing

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penoc synovitis involving the perineals.

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You'll note here case one adhesions

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between the tendon and the sheet.

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And here extensive fibrotic material

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between the tendon and the distended tendon sheet.

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S stenosing teno synovitis.

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Now what do we do when we see Teno synovial fluid about some

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of these tendon groups?

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Well, in general, particularly with regard

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to the medial flexor tendons, small amounts

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of fluid about those medial flexor tendons

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generally considered normal.

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Keeping in mind that even larger amounts about the flexor

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lysis longest tendon in its tendon sheet can be normal

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if you have a large ankle effusion

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because it communicates in a significant number of persons

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with the ankle joint.

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When you have more extensive fluid

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with inflammatory reaction in the adjacent tissues,

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then you're dealing with teno synovitis, in this case,

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posterior tibials, teno synovitis.

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I can't tell you how much fluid changes from

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normal to this condition.

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Alright, I don't think there are any great criteria

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that have been described in the literature.