Reason: erosive t-n disease: synovitis History: pain and swelling follow up mri TENDONS: There is mild increased signal intensity within the posterior tibialis tendon, on the short TE sequences, as it courses posterior to the medial malleolus suggesting a mild tendinosis. There is spurring of the adjacent medial malleolus and more proximally, there is a small amount of fluid within the tendon sheath that is not necessarily of any clinical significance. The flexor digitorum longus and flexor hallucis longus appear intact. The peroneal tendons appear intact. The anterior tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Moderate osteoarthritic changes affecting the talonavicular joint are again seen perhaps secondary to an underlying chronic inflammatory arthritis. There are focal subchondral lesions within the navicular and talus which may represent degenerative cysts or chronic erosions, but these appear similar to the prior study. We see no evidence of disease progression at the talonavicular joint and the edema within the navicular seen on the prior examination has resolved. There is a small amount of fluid noted within the dorsal recess of the talonavicular joint appearing similar to the prior study. There are arthritic changes along the subtalar joint appearing similar to the prior study, including cysts and/or chronic erosions along the medial facet. There is edema within the sustentaculum tali of the calcaneus which has decreased slightly when compared to the prior study. There is mild edema within the lateral aspect of the body of the talus which is new when compared to the prior study but nonspecific. There are also small poorly defined foci of signal abnormality, best seen on the STIR sequences, within the tibial plafond, the calcaneus near the calcaneocuboid and subtalar articulations, the lateral cuneiform, as well as within the anterior and posterior portions of the cuboid. The etiology and significance of these foci is uncertain. They could represent small islands of red marrow not evident on the prior study or perhaps reflect altered biomechanics. Their proximity to the joints also raises the possibility of small subchondral cysts, but they do not appear to disrupt the articular surface and therefore erosions are considered unlikely. Incompletely imaged on this study is mild edema within the proximal diaphysis of the fourth metatarsal. This is nonspecific but could represent stress reaction in the correct clinical context.
1. Osteoarthritic changes of the talonavicular and subtalar joints may be due to an underlying chronic inflammatory arthritis. We see no evidence of disease progression at these joints. The edema within the navicular and sustentaculum tali of the calcaneus has decreased when compared to the prior study.2. There is mild edema type signal within the lateral aspect of the body of the talus which is nonspecific, but is new when compared to the prior study.3. Small foci of signal abnormality, best seen on the STIR sequences, within the tibial plafond, lateral cuneiform, calcaneus, and cuboid are likewise nonspecific and may represent altered biomechanics or small islands of reconverted red marrow. They do not appear to disrupt the articular surface and therefore erosions are considered unlikely.4. Mild nonspecific edema within the proximal diaphysis of the fourth metatarsal is incompletely imaged on this study and could conceivably represent stress reaction in the correct clinical context.