Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus in a Division I Tennis Player

Apr 21

Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus in a Division I Tennis Player

Tenosynovial Chondromatosis is a rare condition characterized by multinodular cartilaginous proliferation that arises from the tenosynovial membrane, commonly affecting adults in the third to fifth decade of life. Dr. Mederic M. Hall recently published an article in Clinical Journal of Sports Medicine titled Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus in a Division I Tennis Player, which highlights the first reported case of tenosynovial chondromatosis (TC) in a collegiate athlete.

 

The case involved a 20-year-old female Division I tennis player who presented with posterior ankle pain that had developed during a tournament several days prior to presentation.  She was initially diagnosed with posterior tibial tendinitis and treated conservatively, which failed to improve her pain.

 

On exam, she was found to have swelling posterior to the medial malleolus, palpable crepitus at the ankle, and a mild deficit of plantar flexion when compared to the right.  Ultrasound revealed both hypoechoic fluid and multiple hyperechoic bodies within the tendon of the flexor hallucis longus sheath.  Subsequent MRI was consistent with primary TC.  The patient underwent ankle arthroscopy that found multiple rice-like loose bodies within the FHL tendon sheath.  Examination of the loose bodies confirmed the diagnosis of primary TC.  After participating in a multi-faceted rehabilitation program, she returned to unrestricted participation at postoperative week 8.

 

Only a few articles report TC in the ankle, none of which include a collegiate athlete.  The current study is the first reported case of TC in a young, collegiate athlete.  The case helps broaden the differential diagnosis of a relatively common ailment amongst collegiate athletes and highlights the effectiveness of ultrasound as a diagnostic tool in the work-up of musculoskeletal pain.

 

Article link: http://www.ncbi.nlm.nih.gov/pubmed/25514138

 

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