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Kim, Kim, Choi, Shon, Park, Cho, and Lee: Stenosing Peroneus Brevis Tendinitis Caused by Peroneus Quartus Tendon
Case Report
Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(1): 83-87.

Published online: 28 February 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.1.83

Stenosing Peroneus Brevis Tendinitis Caused by Peroneus Quartus Tendon

Dong-Soo Kim, M.D., Yong-Min Kim, M.D., Eui-Sung Choi, M.D., Hyun-Chul Shon, M.D., Kyoung-Jin Park, M.D., Byung-Ki Cho, M.D., Hyung-Joon Lee, M.D.

Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Correspondence to: Byung-Ki Cho, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital, 62, Heungdeok-gu, Gaesin-dong, Cheongju 360-711, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, titanick25@yahoo.co.kr

Received 12 June 2009       Accepted 31 August 2009

Copyright © 2010 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Peroneus quartus tendon is one of a group of accessory peroneal tendons present in humans. Associated pathologies include an attritional tear in the peroneus tendon, stenosing tendinitis, and peroneal tendon subluxation or dislocation. A 22-year old female patient, who presented suffering with lateral ankle pain and instability after ankle sprain, visited this hospital. The physical examination and MRI indicated a longitudinal tear of peroneus brevis tendon or chronic stenosing tendinitis caused by peroneus quartus tendon. Tenosynovectomy and an excision of the peroneus quartus tendon were performed. Satisfactory results were obtained at the 1 year follow-up after surgery. Orthopedic surgeons should consider the possible presence of the peroneus quartus tendon in a differential diagnosis of chronic lateral ankle pain.

Keywords: stenosing peroneus brevis tendinitis, peroneus quartus tendon

Figures and Tables

Figure 1
Drawing illustrates a peroneus quartus tendon (arrowhead) located posterior to the peroneus brevis (long arrow) and peroneus longus (short arrow) tendons. Its most common insertion site is the retrotrochlear eminence of calcaneus (curved arrow).
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Figure 2
Sequential axial MR images show an accessory tendon (arrowhead) behind peroneus longus (long arrow) and peroneus brevis (short arrow) tendon. (A, B) This accessory tendon identified with distinct tendon slip within the muscle belly is a peroneus quartus tendon simulating a torn peroneus brevis tendon. (C, D) A peroneus quartus tendon (arrowhead) located close to its insertion into retrotrochlear eminence (curved arrow).
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Figure 3
Operative Photographs showing the peroneus brevis tendon (short arrow) with low-lying muscle belly (arrowhead) (long arrow: peroneus longus tendon).
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Figure 4
(A) Operative Photograph showing the peroneus quartus muscle held with a mosquito forcep in retromalleolar groove. (B) The peroneus quartus tendon (arrowhead) after excision of low-lying peroneus brevis muscle belly (long arrow: peroneus longus, short arrow: peroneus brevis).
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