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Journal of Ultrasound

, Volume 17, Issue 2, pp 113–123 | Cite as

Ultrasound of tibialis anterior muscle and tendon: anatomy, technique of examination, normal and pathologic appearance

  • Ajay Varghese
  • Stefano BianchiEmail author
Original Article

Abstract

Lesions of the tibialis anterior muscle and tendon are not frequently reported in international literature although pathology is not rare. Pathology can be spontaneous, associated with arthropathy or more generalized conditions. Clinical assessment may not be sufficient for distinguishing conditions like tendinopathy, tears, bursitis, etc. Therefore, imaging studies are necessary to plan appropriate therapy. US has a number of advantages, including widespread availability, absence of contraindications and low cost. It can also be used for dynamic studies of the muscle during contraction and relaxation. This article reviews the anatomy of the tibialis anterior, normal variants, the technique used for standard US examination of this muscle and tendon, its normal appearance on US and the sonographic characteristics of the most common lesions that affect it including tips on US-guided injections used for treatment.

Keywords

Tibialis anterior Muscle Tendon Sonography 

Riassunto

Le lesioni del muscolo tibiale anteriore e del suo tendine non hanno un’ampia eco nella letteratura internazionale, anche se la patologia del tibiale anteriore non è rara. Questa può essere spontanea, associata ad artropatia o a condizioni più generali. La clinica spesso può non essere sufficiente per distinguere lesioni quali la tendinopatia, le rotture, le borsiti, ecc., quindi può essere necessario ricorrere alla diagnostica per immagini, per un appropriato trattamento terapeutico. L’ecografia ha numerosi vantaggi quali l’ampia diffusione, l’assenza di controindicazioni, il basso costo. Può essere utilizzata per studi dinamici con muscoli in contrazione e rilasciamento. Questo articolo rivaluta l’anatomia del tibiale anteriore, le varianti del normale, l’aspetto ecografico normale e le caratteristiche ecografiche delle lesioni più frequenti, comprende una trattazione dei trattamenti terapeutici ecoguidati.

Notes

Conflict of interest

Ajay Varghese and Stefano Bianchi declare that they have no conflict of interest.

Human and animal studies

The study described in this article did not include any procedures involving humans or animals.

References

  1. 1.
    Borley NR, Healy JC, Collins P, Johnson D, Crossman AR, Mahadevan V et al (2008) Leg. In: Standring S (ed) Grays anatomy, 40th edn. Churchill Livingstone Elsevier, New York, p 1417Google Scholar
  2. 2.
    Saraffian SK (1993) Retaining systems and compartments. In: Saraffian SK, Kelikian AS (eds) Anatomy of the foot and ankle: descriptive, topographic, functional. Lippincott, Philadelphia, pp 113–118Google Scholar
  3. 3.
    Lee MH, Chung CB, Cho JH, Mohana-Borges AV, Pretterklieber ML, Trudell DJ, et al (2006) Tibialis anterior tendon and extensor retinaculum: imaging in cadavers and patients with tendon tear. AJR 187(2):W161–8CrossRefGoogle Scholar
  4. 4.
    Saraffian SK, Kelikian AS (2011) Tendon sheaths and bursae. In: Saraffian SK, Kelikian AS (eds) Anatomy of the foot and ankle: descriptive, topographic, functional. Lippincott, Philadelphia, p 292Google Scholar
  5. 5.
    Musial WW (1963) Variations of the terminal insertions of the anterior and posterior tibial muscles in man. Folia Morphol 22:237–247Google Scholar
  6. 6.
    Arthornthurasook A, Gaew Im K (1990) Anterior tibial tendon insertion: an anatomical study. J Med Assoc Thai 73:692–696PubMedGoogle Scholar
  7. 7.
    Brenner E (2002) Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus. Clin Anat 15:217–223CrossRefGoogle Scholar
  8. 8.
    Bianchi S, Martinoli C, Gaignot C, De Gautard R, Meyer JM (2005) Ultrasound of the ankle: anatomy of the tendons, bursae and ligaments. Semin Musculoskelet Radiol 9:243–259CrossRefGoogle Scholar
  9. 9.
    Petersen W, Stein V, Tillmann B (1999) Blood supply of the tibialis anterior tendon. Arch Orthop Trauma Surg 119:371–375CrossRefGoogle Scholar
  10. 10.
    Piat C, Wybier M (2010) Le tendon tibial antérieur. Entretiens de Bichat 8–12Google Scholar
  11. 11.
    McCreesh K, Egan S (2011) Ultrasound measurement of the size of the anterior tibial muscle group: the effect of exercise and leg dominance. Sports Med Arthrosc Rehabil Ther Technol 3:18CrossRefGoogle Scholar
  12. 12.
    Martinson H, Stokes MJ (1991) Measurement of anterior tibial muscle size using real-time ultrasound imaging. Eur J App Physiol 63:250–254CrossRefGoogle Scholar
  13. 13.
    Bianchi S, Martinoli C (2007) Ankle. In: Ultrasound of the musculoskeletal system. Springer pp 773–834Google Scholar
  14. 14.
    Pillen S (2010) Skeletal muscle ultrasound. Eur J Transl Myol 1:145–155CrossRefGoogle Scholar
  15. 15.
    Bianchi S, Abdelwahab IF, Mazzola CG, Ricci G, Damiani S (1995) Sonographic examination of muscle herniation. J Ultrasound Med 14:357–360CrossRefGoogle Scholar
  16. 16.
    Beggs I (2003) Sonography of muscle hernias. AJR 2:395–399CrossRefGoogle Scholar
  17. 17.
    Bates DG (2001) Dynamic ultrasound findings of bilateral anterior tibialis muscle herniation in a pediatric patient. Pediatr Radiol 31:753–755CrossRefGoogle Scholar
  18. 18.
    Bianchi S, Martinoli C (2007) Muscle and tendon. In: Ultrasound of the musculoskeletal system. Springer pp 45–97Google Scholar
  19. 19.
    Kim SJ, Hong SH, Jun WS et al (2011) MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics 31:319–332CrossRefGoogle Scholar
  20. 20.
    Finlay K, Friedman L, Ainsworth K (2007) Calcific myonecrosis and tenosynovitis: sonographic findings with correlative imaging. J Clin Ultrasound 35:48–51CrossRefGoogle Scholar
  21. 21.
    O’Dwyer HM, Al-Nakshabandi NA, Al-Muzahmi K, Ryan A, O’Connell JX, Munk PL (2006) Calcific myonecrosis: keys to recognition and management. AJR 187:W67–W76CrossRefGoogle Scholar
  22. 22.
    Banks KP, Bui-Mansfield LT, Chew FS, Collinson F (2005) A compartmental approach to the radiographic evaluation of soft tissue calcifications. Semin Roengenol 40(4):391–407CrossRefGoogle Scholar
  23. 23.
    Beischer AD, Beamond BM, Jowett AJ, O’Sullivan R (2009) Distal tendinosis of the tibialis anterior tendon. Foot Ankle Int 30:1053–1059CrossRefGoogle Scholar
  24. 24.
    Mengiardi B, Pfirrmann CW, Vienne P et al (2005) Anterior tibial tendon abnormalities: MR imaging findings. Radiology 235:977–984CrossRefGoogle Scholar
  25. 25.
    Grundy JR, O’Sullivan RM, Beischer AD et al (2010) Operative management of distal tibialis anterior tendinopathy. Foot Ankle Int 31:212–219CrossRefGoogle Scholar
  26. 26.
    Jacob D, Bianchi S (2011) Le tendon tibial antérieur. Societe D’Imagerie Musculo-squelettique. Opus XXXVIII Le piedGoogle Scholar
  27. 27.
    Bulut M, Yilmaz E, Karakurt L, Özercan MR (2013) Rice body formation characterized by the chronic non-specific tenosynovitis in the tibialis anterior tendon. Acta Orthop Traumatol Turc 47:142–145CrossRefGoogle Scholar
  28. 28.
    Maquirriain J, Sammartino M, Ghisi JP, Mazzuco J (2003) Tibialis anterior tenosynovitis: avoiding extensor retinaculum damage during endoscopic debridement. Arthroscopy 19:E9CrossRefGoogle Scholar
  29. 29.
    Bianchi S, Zwass A, Abdelwahab IF, Zoccola C (1994) Evaluation of tibialis anterior tendon rupture by ultrasonography. J Clin Ultrasound 22:564–566CrossRefGoogle Scholar
  30. 30.
    Gallo RA, Kolman BH, Daffner RH, Sciulli RL, Roberts CC, DeMeo PJ (2004) MRI of tibialis anterior tendon rupture. Skeletal Radiol 33:102–106CrossRefGoogle Scholar
  31. 31.
    Khoury NJ, el-Khoury GY, Saltzman CL, Brandser EA (1996) Rupture of the anterior tibial tendon: diagnosis by MR imaging. AJR 167:351–354CrossRefGoogle Scholar
  32. 32.
    Wulker N, Hurschler C, Emmerich J (2003) In vitro simulation of stance phase gait. II: simulated anterior tibial tendon dysfunction and potential compensation. Foot Ankle Int 24:623–629CrossRefGoogle Scholar
  33. 33.
    Dooley BJ, Kudelka P, Menelaus MB (1980) Subcutaneous rupture of the tendon of tibialis anterior. J Bone Jt Surg Br 62-B:471–2CrossRefGoogle Scholar
  34. 34.
    Geppert MJ, Sobel M, Hannafin JA (1993) Microvasculature of the tibialis anterior tendon. Foot Ankle 14:261–264CrossRefGoogle Scholar
  35. 35.
    Resnick D (1995) Diagnosis of bone and joint disorders. 3rd edn. W. B. Saunders, Philadelphia, pp 667–8Google Scholar
  36. 36.
    Farooki S, Ashman C, Lee J, Guttikonda S, Yu J (2002) Common bursae around the body: a review of normal anatomy and magnetic resonance imaging findings. Radiologist 9:209–211CrossRefGoogle Scholar
  37. 37.
    Pocket Atlas of Human Anatomy: Founded by Heinz Feneis Basic Sciences (Thieme) Dauber 5th Rev edn. pp 132–133Google Scholar
  38. 38.
    Hirji Z, Hunjun JS, Choudur HN (2011) Imaging of the Bursae. J Clin Imaging Sci 1:22CrossRefGoogle Scholar
  39. 39.
    Molini L, Mariacher S, Bianchi S (2012) US guided corticosteroid injection into the subacromial-subdeltoid bursa: technique and approach. J Ultrasound 15:61–68CrossRefGoogle Scholar
  40. 40.
    Laurell L, Court-Payen M, Nielsen S, Zak M, Boesen M, Fasth A (2011) Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J 9:4CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Dorset County Hospital NHS Foundation TrustDorchesterUK
  2. 2.CIM SA Cabinet Imagerie MédicaleGenevaSwitzerland

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