0:00

Problems with the flexor lysis.

0:02

Longest tendon are really not so common

0:05

as the other abnormalities we've talked about.

0:08

We see this particularly in athletes, particularly those

0:12

in ballet dancers.

0:14

There are certain vulnerable levels along the course

0:17

of the flexor lysis longest tendon.

0:21

We can get other problems tethering in the region

0:23

of the O Trigonum trigger toe, also known

0:27

as ants.

0:29

But in general, high grade partial tears

0:32

or complete tears are unusual.

0:36

I wanted to show you one example here.

0:39

This is a complete tear involving the flexor lysis longest

0:43

tendon with a tendonous gap shown

0:47

by these black arrows.

0:50

The flexor lysis longest tendon can be entrapped at several

0:54

different areas related to fractures,

0:57

certain articular diseases, accessory ossification centers.

1:02

The one that I wanted to emphasize was

1:04

what may occur when you have a large O trigonum

1:08

or a prominent trigonal process of the S.

1:12

Here with an O trigonum, there is entrapment of the tendon

1:16

as it passes that level,

1:18

and the clue to the diagnosis is to find teno synovial fluid

1:24

above the level of the trigonum and not below the level.

1:28

That's a use, a useful sign for this particular condition.

1:33

Tbi anterior tendon, again, not something, uh, abnormalities

1:37

that we see often.

1:39

It's been described in certain athletes,

1:42

particularly those involved in soccer.

1:44

Also in various types of running and sprinting.

1:48

It may produce a mass lesion.

1:50

So the history you may get is a mass along the antra aspect

1:55

of the level of the ankle or just below it, rule out tumor.

1:59

And it relates to a full, uh, complete tear

2:04

where retracted fibers produce this mass.

2:07

And there are some other associated findings.

2:10

This is the typical location typically located near

2:14

or between the superior

2:17

and inferior extensor RET macular.

2:21

I'll show you two examples. First case two on your right.

2:25

This is a complete

2:26

or full thickness tear with a tendonous gap

2:30

outlined by the arrows.

2:32

And then I wanted to show you this.

2:34

This is partial tearing,

2:36

maybe even split full thickness tearing.

2:40

Okay. At one of the distal attachments.

2:43

Remember, this tendon attaches classically to this bone,

2:47

the medial canfor and base of the first.

2:50

There are variations,

2:52

but it was suggested a number of years ago

2:54

that when you have pathology there,

2:57

you often see an exaggerated concavity along the medial

3:02

aspect of the medial form.