Surgical Treatment for Stenosing Peroneal Tenosynovitis

Abstract

Category: Ankle Introduction/Purpose: Stenosing Peroneal Tenosynovitis is an uncommon entity that is equally difficult to diagnose. In our practice, we have found 14 patients with this diagnosis. They were all successfully treated with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Further, the ultrasound guided anesthetic injection of the tendon sheath preoperatively essential in confirming this diagnosis and evaluating for successful outcomes after surgical intervention. Methods: 14 patients were diagnosed with Stenosing Peroneal Tenosynovitis. Upon initial presentation, the patients all reported a persistent history of pain along the ankle and had exhausted conservative treatment options. Patients with MRIs had images that appeared normal. In order to confirm the diagnosis as Stenosing Peroneal Tenosynovitis, ultrasound guided injections of anesthetics were administered into the peroneal tendon sheath. If the injection alleviated the pain, this confirmed the diagnosis of Stenosing Peroneal Tenosynovitis. Patients also had neurological consults to rule out possible sural neuritis. In patients with a confirmed diagnosis of stenosing peroneal tenosynovitis, we proceeded with surgical intervention. They underwent surgery between 2006 and 2014 by two fellowship trained orthopedic surgeons at one institution. Retrospective chart review was performed and functional outcomes were assessed pre-and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Results: All patients that underwent this procedure were given the Foot and Ankle Outcome Score (FAOS) and Short Form 12 (SF-12) general health questionnaire pre-operatively. Questionnaire results were collected post-operatively and were successfully obtained at one year or greater from 11 patients. Of these 11 patients, all showed significant improvements (student t test used, p<0.05) in four of five categories of the FAOS (pain, daily activities, quality of life) as well as significant improvement in their overall SF-12 score and pain scale score (Table). Conclusion: Stenosing peroneal tenosynovitis is an uncommon entity. The presentation of the disease is one of persistent lateral sided ankle pain with minimal radiologic findings. We present a case series in which the peroneal tendon sheath was diagnostically injected with an anesthetic to determine if the pain could be relieved. In each of the cases, symptomatic improvement was obtained following the injection, helping to confirm the diagnosis. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe, this diagnostic injection is paramount in assisting with determining the success of surgical outcome.