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So here is our first case.

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Um, we have the axial T one images, axial pd,

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fat suppressed coronal, oblique, uh, pd, fat suppressed

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and sagal T one weighted images.

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This is a 26-year-old woman who had a history

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of right lateral ankle pain.

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The symptoms began while she was rock climbing.

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So as we scroll through our axial images, um, we can see

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that at the lateral ankle

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and the region of the patient's symptoms,

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there's quite a lot of tenal synovial fluid

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surrounding the perineal tendons.

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And then the tendons themselves look like they're

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abnormally positioned.

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Um, so scrolling to see which tendons we think are affected.

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It's actually both tendons.

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So here's our longest tendon, completely dislocated outside

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of the retro mall groove.

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And then looking at our peroneous brevis tendon, um,

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it looks like there are multiple

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longitudinal split tears within the tendon

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and that's allowing some of the lateral most slips

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of the tendon to dislocate.

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Um, even though the, the rest

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of the peroneus revis tendon looks like it's in a

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relatively normal position.

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So normally these tendons are held in place in the retro

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mall groove by the superior peroneal Retin aum, which Dr.

1:21

Resnick mentioned, um, on mr.

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This should look like a nice thin,

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hypo intense band of tissue.

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Um, it should attach normally anteriorly

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to the lateral fibular periosteum.

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It's gonna wrap around the tendons

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and then usually posteriorly it'll attach to the deep

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and superficial, uh, upper neuros

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of the posterior compartment.

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Um, and then as you come down to the calcaneus, uh,

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the superior peroneal reticulum should have also an

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attachment that's a little bit posterior

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to the calcaneal attachment of the calcan fibular ligament.

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So if we look here at our patient, um,

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the normal anterior attachment is, is not present.

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It looks like we have that, uh, periosteal stripping.

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Uh, I believe Dr.

2:16

Resnick briefly showed you that Odin classification.

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Um, and then if we look at the RET AUM proper, we can see

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that the signal is not that nice to hypo intense signal.

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And there are probably some areas

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of discontinuity within the substance

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of the Retin AUM itself.

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So going back to that classification system, if you were

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to give a classification, the type one, um, would be the,

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uh, injury

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of the ret inoculum from the periosteum type two within,

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within the substance of itself.

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Um, the ulu, if there was an avulsion fracture,

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that would be a type three.

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And then if you injured them more posterior

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portions of the ulu,

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It would be a type four.

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So here, I guess maybe a type one slash two

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'cause we have both the, um, periosteal stripping, forming

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that pouch for the tendons to dislocate into,

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and then also some injury to the ulu.

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If we come further inferiorly to the level

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of the perineal tubercle.

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Um, this should be where the

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inferior perineal ret macular attaches

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to the retro trochlear eminence.

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Um, here, I think the tendons are still a little bit too,

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um, laterally positioned with respect to the calcaneus.

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Normally, I would expect the tendon

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to be more closely applied to the surface of the calcaneus.

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Still a lot of 10 synovial fluid.

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I'm not really seeing a nice, um, thin hyperintense,

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inferior perineal reticulum here.

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So I think that's probably also torn here.

3:54

Um, here I've pulled up the coronal oblique images.

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I don't think we really needed them in this case

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to evaluate our perineal tendons sometimes.

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I do think that it's helpful, uh, to look at the tendons

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because it gives you a true cross-sectional, um, evaluation

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of the tendons as they make their curve, um,

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their first curve beneath the, um, fib tip.

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Um, but here the tendon pathology in brevis was so obvious

4:21

that you could have seen them in any of the imaging planes.

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I.