J Korean Orthop Assoc.  2010 Feb;45(1):83-87. 10.4055/jkoa.2010.45.1.83.

Stenosing Peroneus Brevis Tendinitis Caused by Peroneus Quartus Tendon

• Kim DS
• Kim YM
• Choi ES
• Shon HC
• Park KJ
• Cho BK
• Lee HJ

• KMID: 2185599
• DOI: http://doi.org/10.4055/jkoa.2010.45.1.83

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.

Keyword

stenosing peroneus brevis tendinitis; peroneus quartus tendon

MeSH Terms

Animals
Ankle
Diagnosis, Differential
Dislocations
Female
Follow-Up Studies
Humans
Orthopedics
Physical Examination
Sprains and Strains
Stress, Psychological
Tendinopathy
Tendons

Figure

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  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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