Tenography in tenosynoviopathies of the posterior tibial tendon

PURPOSE OF THE STUDY: The authors wanted to study diagnosis contribution and therapeutic importance of tenography in posterior tibial tendon tenosynoviopathies. MATERIAL: The series included 42 patients (26 females and 16 males) from 23 to 69 years old. The affection had a course for about two years. A trigger or promoter factor was founded in 32 cases. Clinical examination found only 12 standard feet. Biological exams were normal. METHODS: All patients had a tenography. When tenosynoviopathy was diagnosed, the surgeon injected cortivazol in the sheath by the catheter, within the extra-tendinous space. In case of treatment failure, a synovectomy was realized with possible tendinous suture, under the protection of a weight bearing plaster cast for 21 days. RESULTS: Pathological features: we have founded 26 major irregularities of the sheath, extensive with scalloped outlines of which 8 were supra-malleolar and 18 sub-malleolar, 15 irregularities located at the level of the sheath outline of which 4 were supra-malleolar and 11 sub-malleolar and with a tear of 1 cm length. Long term results: among 36 reviewed patients, pain disappeared in 29 cases, after only one injection (21 cases), or after a surgical treatment (8 cases). DISCUSSION: Tenography has for us great interest for the diagnosis of a tenosynoviopathy, allowing in the same time an extra-tendinous injection of corticoid in the sheath itself. But it doesn't always allow to make a diagnosis of a tendinous tear. A part of our failures can be secondary to these tears. According to our results it could be recommended to practice in a first time a tenotomodensitometry (teno TDM). In case of a tear, a surgical treatment by synovectomy with suture may be proposed first, for a tenosynoviopathy an injection must be realizes. CONCLUSION: Tenography allows a precise diagnosis and in the same time, a treatment by injection. The tendinous tears require a surgical suture but are better diagnosed on a teno TDM.