I am a bit confused by the appearance of the Superomedial Spring (CNL)
ligament.
My question is: Is it torn or not?
The PTT looks normal, with some tenosynovitis, inserting onto a normal
appearing Type 2 accessory navicular.
In the Cor images there is nothing (White Arrow) between the talar head
and Acc Navicular (Yellow Arrow)….which, as I understand it, should mean
there is a SM-CNL tear.
In the 2nd set of Cor images I think the Blue Arrow shows the
posteroinferior portion of the SM-CNL, which, in that image, seems
continuous with the Tibiospring ligament.
But in the Axial images, I’m not convinced it looks torn….maybe
partially?
Or is the Accessory Navicular changing the anatomic relationships and
confusing me?
There is some localized ST edema cranial to the accessory navicular, and
superficial to the SM-CNL….which is in her region of pain.
I’ve included images from an excellent Radiol article by Mengiardi et al
2005….which is the basis for what I thought I understood.
[image: CNL 53F query ptt.jpeg]
[image: CNL 53F query ptt 2.jpeg]
[image: CNL 53F query ptt3.jpeg]
[image: CNL 53F query ptt4.jpeg]
[image: CNL 53F query ptt5.jpeg]
[image: CNL 53F query ptt Cor Ref.jpeg]
[image: CNL 53F query ptt6.jpeg]
1 thought on “53F new onset medial pain to evaluate the PTT MRI please help”
avneesh.chhabra
Dr. Umans,
You have thick slices- consider using 3D
On coronal it looks torn but its uncommon finding without ptt tear and talar fault
There is a normal recess b/w SM and MPO bundle– here it is too wide- likely torn SML
See attached our articles for ref.. have 3D images
Omar H, Saini V, Wadhwa V, Liu G, Chhabra A. Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging. Eur J Radiol. 2016 Nov;85(11):2133-2143. doi: 10.1016/j.ejrad.2016.09.023. Epub 2016 Sep 24. PMID: 27776669.
Chhabra A, Soldatos T, Chalian M, Faridian-Aragh N, Fritz J, Fayad LM, Carrino JA, Schon L. 3-Tesla magnetic resonance imaging evaluation of posterior tibial tendon dysfunction with relevance to clinical staging. J Foot Ankle Surg. 2011 May-Jun;50(3):320-8. doi: 10.1053/j.jfas.2011.02.004. Epub 2011 Apr 2. PMID: 21459628.
________________________________
Sent: Friday, January 28, 2022 1:37 PM
EXTERNAL MAIL
I am a bit confused by the appearance of the Superomedial Spring (CNL) ligament.
My question is: Is it torn or not?
The PTT looks normal, with some tenosynovitis, inserting onto a normal appearing Type 2 accessory navicular.
In the Cor images there is nothing (White Arrow) between the talar head and Acc Navicular (Yellow Arrow)….which, as I understand it, should mean there is a SM-CNL tear.
In the 2nd set of Cor images I think the Blue Arrow shows the posteroinferior portion of the SM-CNL, which, in that image, seems continuous with the Tibiospring ligament.
But in the Axial images, I’m not convinced it looks torn….maybe partially?
Or is the Accessory Navicular changing the anatomic relationships and confusing me?
There is some localized ST edema cranial to the accessory navicular, and superficial to the SM-CNL….which is in her region of pain.
I’ve included images from an excellent Radiol article by Mengiardi et al 2005….which is the basis for what I thought I understood.
[CNL 53F query ptt.jpeg]
[CNL 53F query ptt 2.jpeg]
[CNL 53F query ptt3.jpeg]
[CNL 53F query ptt4.jpeg]
[CNL 53F query ptt5.jpeg]
[CNL 53F query ptt Cor Ref.jpeg]
[CNL 53F query ptt6.jpeg]
You have thick slices- consider using 3D
On coronal it looks torn but its uncommon finding without ptt tear and talar fault
There is a normal recess b/w SM and MPO bundle– here it is too wide- likely torn SML
See attached our articles for ref.. have 3D images
Omar H, Saini V, Wadhwa V, Liu G, Chhabra A. Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging. Eur J Radiol. 2016 Nov;85(11):2133-2143. doi: 10.1016/j.ejrad.2016.09.023. Epub 2016 Sep 24. PMID: 27776669.
Chhabra A, Soldatos T, Chalian M, Faridian-Aragh N, Fritz J, Fayad LM, Carrino JA, Schon L. 3-Tesla magnetic resonance imaging evaluation of posterior tibial tendon dysfunction with relevance to clinical staging. J Foot Ankle Surg. 2011 May-Jun;50(3):320-8. doi: 10.1053/j.jfas.2011.02.004. Epub 2011 Apr 2. PMID: 21459628.
This is a rsna pdf
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwin-4f-mtX1AhVgk2oFHaXLDFYQFnoECAwQAQ&url=http%3A%2F%2Fxrayhead.com%2Fimages%2Ftutorial_spring.pdf&usg=AOvVaw3YiLvxjAFL7jKthm-sGtlX
Best!
AC
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>
http://www.utsouthwestern.edu<http://www.utsouthwestern.edu/>
________________________________
Sent: Friday, January 28, 2022 1:37 PM
EXTERNAL MAIL
I am a bit confused by the appearance of the Superomedial Spring (CNL) ligament.
My question is: Is it torn or not?
The PTT looks normal, with some tenosynovitis, inserting onto a normal appearing Type 2 accessory navicular.
In the Cor images there is nothing (White Arrow) between the talar head and Acc Navicular (Yellow Arrow)….which, as I understand it, should mean there is a SM-CNL tear.
In the 2nd set of Cor images I think the Blue Arrow shows the posteroinferior portion of the SM-CNL, which, in that image, seems continuous with the Tibiospring ligament.
But in the Axial images, I’m not convinced it looks torn….maybe partially?
Or is the Accessory Navicular changing the anatomic relationships and confusing me?
There is some localized ST edema cranial to the accessory navicular, and superficial to the SM-CNL….which is in her region of pain.
I’ve included images from an excellent Radiol article by Mengiardi et al 2005….which is the basis for what I thought I understood.
[CNL 53F query ptt.jpeg]
[CNL 53F query ptt 2.jpeg]
[CNL 53F query ptt3.jpeg]
[CNL 53F query ptt4.jpeg]
[CNL 53F query ptt5.jpeg]
[CNL 53F query ptt Cor Ref.jpeg]
[CNL 53F query ptt6.jpeg]
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