Review Article Ultrasonography 2017 364 321335 httpsdoiorg1014366usg17008 Ultrasonography of the ankle joint Jung Won Park 1 Sun Joo Lee 1 Hye Jung Choo 1 Sung Kwan Kim 1 HeuiChul Gwak 2 SungMoon Lee 3 1 Department of Radiology and Inje University Busan Paik Hospital Inje University College of Medicine Busan Korea 2 Department of Orthopedic Surgery Inje University Busan Paik Hospital Inje University College of Medicine Busan Korea 3 Department of Radiology Dae Kyung Imaging Center Daegu Korea Correspondence to Sun Joo Lee MD Department of Radiology Inje University Busan Paik Hospital Inje University College of Medicine 75 Bokjiro Busanjingu Busan 47392 Korea Tel 82518906579 Fax 82518961085 Email sunjulee98navercom Received February 7 2017 Revised April 3 2017 Accepted April 5 2017 Published online April 5 2017 Copyright 2017 Korean Society of Ultrasound in Medicine KSUM This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License httpcreativecommonsorglicensesbync30 which permits unrestricted noncommercial use distribution and reproduction in any medium provided the original work is properly cited Abstract Ankle disorders are a relatively common pathological condition and ankle injuries account for approximately 14 of sportsrelated orthopedic emergency visits Various imaging modalities can be used to make a diagnosis in cases of ankle pain however ultrasound US has several benefits for the evaluation of ankle pain especially in the tendons ligaments and nerves of the ankle The purpose of this article is to review the common causes of ankle pathology with particular reference to US features In addition the importance of a dynamic evaluation and a stress test with US is emphasized Keywords Ultrasonography Ankle Anatomy Tendons Ligaments Nerves Go to Introduction Ankle injuries account for approximately 14 of sportsrelated orthopedic emergency visits 1 Various pathological conditions can affect the ankle including trauma overuse disorders and inflammatory conditions 2 Several imaging modalities such as computed tomography magnetic resonance imaging and ultrasound US can be used to evaluate the ankle However US has several benefits for the evaluation of the tendons and ligaments of the ankle such as its suitability to be integrated with a dynamic assessment and a stress test its ability to provide realtime analysis its avoidance of the risk of radiation exposure and its costeffectiveness 3 US is especially powerful when used to evaluate a tear subluxation or dislocation in a dynamic examination and when performing a comparison with the contralateral extremity 4 Dynamic imaging with muscle contraction or passive movement is often helpful Additionally Doppler imaging may be used to distinguish small intrasubstance tears from blood vessels that can occur in a tendinopathic tendon 5 In this article we present findings regarding the use of US for various pathological conditions of the ankle Such conditions can be classified in terms of the anatomical divisions of the ankle such as the tendons ligaments nerves and bones The relationships of the anatomy of the ankle with US examination results have been studied previously therefore we focused on the ultrasonographic features of common pathological entities of the tendons ligaments and nerves of the ankle Go to Normal Anatomy and Technique of US Examination The ankle tendon can be divided into four anatomic groups medial lateral anterior and posterior 3 Each anatomic position contains different types of tendons such as the tibialis posterior flexor digitorum longus and flexor hallucis longus in the medial group the peroneus longus and brevis in the lateral group the tibialis anterior extensor hallucis longus and extensor digitorum longus in the anterior group and the Achilles and plantaris in the posterior group These tendons are frequently oriented longitudinally and are best depicted in the transverse plane 6 The ligaments of the ankle are composed of three ligamentous groups the syndesmotic ligamentous complex the lateral ligamentous complex and the deltoid ligament Routine US examination of the ankle is performed in different positions that allow easy assessment of the medial lateral anterior and posterior aspects Medial The tendons of the medial ankle are the tibialis posterior tendon the flexor digitorum longus tendon and the flexor hallucis longus tendon which run in the anteroposterior direction Transverse images obtained posterior to the medial malleolus posterior tibialis tendon and flexor digitorum longus are detected below the flexor retinaculum Moving the transducer to a more posterior position allows visualization of the flexor hallucis longus tendon between the medial and lateral tubercles of the posterior talar process 3 The medial deltoid ligament has a triangular or fan shape and originates from the apex of the medial malleolus It is divided into a deep layer and a superficial layer The deep layer contains the anterior tibiotalar ligament and posterior tibiotalar ligament while the superficial layer contains the tibionavicular ligament tibiospring ligament and tibiocalcaneal ligament 3 The posterior tibiotalar ligament is the thickest of the medial ligaments of the ankle When this region is evaluated using US the transducer is placed on the tip of the medial malleolus and is then moved posteriorly to the inferior end of the heel in an oblique longitudinal direction The posterior tibiotalar ligament can be identified by its thick striated appearance Lateral The peroneus longus muscle arises from the lateral condyle of the tibia and the proximal fibula and it inserts on the plantar surface of the medial cuneiform bone and the proximal first metatarsal bone The peroneus brevis muscle originates more distally from the distal twothirds of the lateral fibular shaft and inserts on the lateral aspect of the base of the fifth metatarsal bone 7 Transverse images are obtained at the supramalleolar malleolar and inframalleolar segments while tilting the transducer perpendicular to the tendons At the supramalleolar level the peroneus brevis tendon is visualized as a hypoechoic structure located between the peroneus longus tendon and the bone cortex At the malleolar level US can differentiate the two peroneal tendons under the superior peroneal retinaculum with the peroneus longus muscle superiorly In the inframalleolar area the peroneus longus tendon crosses under the peroneal tubercle and the peroneus brevis tendon is located above the peroneal tubercle The ligaments of the lateral ankle consist of the lateral ligamentous complex the anterior talofibular ligament ATFL posterior talofibular ligament PTFL and calcaneofibular ligament CFL 8 The ATFL runs anteriorly from the lateral malleolus and attaches to the lateral side of the talar neck The ATFL is the most vulnerable ligament to inversion injuries On a transverse scan anterior to the lateral malleolus the ATFL can be identified by its straight and striated appearance The CFL runs inferiorly from the lateral malleolus to the posterolateral aspect of the calcaneus For scanning of the CFL the transducer is placed between the lateral malleolus and the posterolateral aspect of the calcaneus and the CFL exhibits a curved course with hypoechogenicity The CFL can be well depicted during dorsiflexion of the ankle on US The PTFL originates from the posterior aspect of the lateral malleolus and inserts into the lateral tubercle of the posterior talar process However it is difficult to evaluate the PTFL by US due to its deep location 9 Anterior When examining of the anterior tendon of the ankle obtaining axial images can allow several tendons to be visualized in a single image and differentiated The tibialis anterior tendon TA is located at the anteromedial aspect of the ankle It descends obliquely to insert into the medial aspect of the first cuneiform The extensor hallucis longus tendon EHL runs parallel and lateral to the TA and the extensor digitorum longus tendon EDL is found in a more lateral position The anterior tibial artery is located below the anterior tendons and runs between the EHL and EDL The deep peroneal nerve is located proximal to the medial aspect of the artery and it crosses the artery distally to descend along its lateral border Posterior The Achilles tendon is a conjoined tendon formed by the fusion of the distal tendon laminae of the soleus and gastrocnemius muscles During its course it rotates 90 laterally so that its soleus component inserts into the posteromedial aspect and its gastrocnemius component inserts into the posterolateral aspect of the calcaneus 3 Go to Pathologies of the Tendon Pathological conditions of the ankle tendons include tendinosis tenosynovitis tears subluxation and dislocation These conditions show similar ultrasonographic features elsewhere in the body 4 Tendinosis results in thickening of the tendon focal or diffuse areas of hypoechogenicity and preservation of a fibrillar appearance 10 It may occasionally be difficult to differentiate an area of tendinosis from a partialthickness tear on US Fig 1 Tendinosis of the peroneus longus tendon Longaxis A and shortaxis B ultrasonography of the peroneus longus tendon arrows shows diffusely enlarged and hypoechoic swelling of the tendon without tendon fiber discontinuity There is no evidence of synovial thickening or synovial fluid collection PL peroneus longus tendon PB peroneus brevis tendon LM lateral malleolus OP os peroneale Tendinitis and tenosynovitis which involve inflammation around the tendon or tendon sheath are common tendon disorders of the ankle The etiology of tendinitis and tenosynovitis is thought to be secondary to trauma repetitive local stress systemic joint disorders such as rheumatoid arthritis or ankylosing spondylitis or infection 10 Tenosynovitis and tendinitis appear as irregularly thickened and hypoechoic synovial membranes or tendons These conditions are usually accompanied by fluid in the tendon sheath or synovial fluid which appears as a target sign in the axial plane and a railtrack in the longitudinal plane 11 Color Doppler can help to determine the degree of activity of the inflammation of the tendon sheath inside the synovium or tendons Fig 2 Tenosynovitis of the extensor digitorum longus Longaxis A and shortaxis B ultrasonography of the extensor digitorum longus shows anechoic distention of the tendon sheath asterisks synovial hypertrophy arrows and increased vascularity on the color Doppler image C EDL extensor digitorum longus Nav navicular bone A tendon tear may be seen as a hypoechoic or anechoic gap in the fibrillarpatterned tendon with retraction of the tendon Importantly the tear site the size of the hypoechoic or anechoic gap and the locations of proximal and distal stumps are very helpful when planning for surgical treatment A tear may be seen as a hypoechoic or anechoic area that interrupts the tendon fibers extending across the tendon in a complete tear or appearing as a focal defect in a partial tear 6 Peroneal Tendon US is highly effective in the diagnosis of peroneal tendon injuries and has been shown to achieve 100 sensitivity 85 specificity and 90 accuracy 12 In peroneal tenosynovitis a large amount of fluid is usually indicative of tenosynovitis However small volumes of fluid within the common peroneal tendon sheath are frequently observed in asymptomatic subjects 13 Occasionally fluid in the tendon sheath of peroneal tendons may be an indirect sign of CFL disruption rather than tenosynovitis 14 Peroneal tendon tears commonly result from excessive tension in a tendon weakened by preexisting tenosynovitis or microtraumas 13 However the most common cause of an acute peroneal longus tendon tear is direct trauma or sportsrelated injury One frequent location of peroneal brevis tears is on the longitudinal split which results in the migration of the peroneal longus tendon into the tendon cleft of the peroneal brevis tendon 15 On US key findings include a previously noted cleft with two distinct hemitendons irregularities of the tendon or features of associated tenosynovitis Fig 3 A boomerang shape of the peroneus brevis tendon is likely to suggest the early stage of a longitudinal tear caused by weakening and thinning of the central part of the tendon 7 Fig 3 Longitudinal tear of the peroneus brevis tendon Shortaxis A and longaxis B ultrasonography scanned at the lateral malleolar area shows that the peroneus brevis tendon is split arrow and divided into two separate bundles of fibers The peroneus longus tendon is intact C An axial T2weighted magnetic resonance image reveals a bisected peroneus brevis tendon arrow and cystic lesion arrowhead posterior to the peroneus longus tendon PB peroneus brevis tendon PL peroneus longus tendon Isolated peroneus longus tears are uncommon and mostly observed at the cuboid bone level On US a partial tear appears as thinned or thickened and presents an irregular hypoechoic internal appearance with loss of the normal fibrillar pattern A fullthickness tear of the peroneus longus tendon is indicated by longitudinal splits or complete tendon discontinuity with retraction Frequently there is associated tenosynovitis 13 Intrasheath subluxation of the peroneal tendons develops when the tendons reverse their anatomic location within the peroneal groove with an intact superior peroneal retinaculum SPR 7 Intrasheath subluxation of the peroneal tendons was divided into two subtypes by Raikin et al 16 In type A the tendons snap over one another and switch their relative positions within the peroneal groove without a tendon tear or disruption of the SPR In type B subluxation of the peroneus longus tendon occurs through a longitudinal split tear within the peroneus brevis tendon which results in a portion of the longus tendon lying deep relative to the brevis tendon at this level 16 Dynamic US examination reveals subluxation of the peroneus brevis and longus tendons over each other within the peroneal groove with an intact SPR while dorsiflexion and an eversion maneuver are performed Fig 4 Dynamic ultrasound of an intrasheath peroneal subluxation Raikin type A Shortaxis ultrasonography over the lateral malleolus is obtained at rest A and during dorsiflexion and eversion of the foot B A The peroneus brevis and peroneus longus tendons lie posterior to the tip of the lateral malleolus B The peroneus longus and peroneus brevis tendons have switched their positions LM lateral malleolus PB peroneus brevis tendon PL peroneus longus tendon Peroneal tendon dislocation occurs when one or both tendons become displaced from the retromalleolar groove often only transiently during ankle movement or muscle contractions 17 This is commonly associated with an SPR injury Fig 5 Dynamic ultrasound of peroneal dislocation Shortaxis ultrasonography over the lateral malleolus is obtained at rest A and during dorsiflexion and eversion of the foot B A The neutral position of the peroneus brevis and peroneus longus tendon which lies posterior to the tip of the lateral malleolus can be seen B The peroneus longus and peroneus brevis tendons become displaced from the retromalleolar groove LM lateral malleolus PB peroneus brevis tendon PL peroneus longus tendon The SPR is composed of fibrous retaining bands that bind down the peroneus longus and brevis tendons An acute SPR injury manifests with ecchymosis swelling and pain at the lateral malleolus and may be mistaken for an ankle sprain The most common mechanism of SPR injury involves the sudden contraction of the peroneal muscles either during an acute inversion injury to the dorsiflexed ankle or during forced dorsiflexion of the everted foot 18 SPR injuries are graded using the Oden classification into four types 19 In type I the SPR and its periosteal attachment are elevated at the level of the fibular groove forming a pouch In type II injuries there is a tear at the attachment of the SPR to the distal fibula Type III injuries consist of an avulsion fracture at the attachment of the SPR to the distal fibula In type IV injuries there is a tear in the SPR at its posterior attachment 19 Achilles Tendon The Achilles tendon is the longest and strongest tendon in the body An Achilles tendon injury is commonly caused by forced and sudden movement at the ankle joint often occurring in active individuals in the third to sixth decades of life with no underlying history 20 The Achilles tendon has a distinct anatomic structure compared to the other tendons of the ankle It is not surrounded by a true synovial sheath however it is surrounded by a paratendon which is composed of a single layer of cells Fig 6A B 21 Therefore instead of tenosynovitis paratendinopathy can occur alone or in combination with the degeneration of this tendon 22 Fig 6 Achilles paratendinopathy Shortaxis A and longaxis B ultrasonography of the left Achilles tendon shows a normal appearance arrowheads of the Achilles tendon Shortaxis C and longaxis D ultrasonography of the right Achilles tendon shows a hypoechoic and thickened paratendon arrows around the Achilles tendon The patient 26yearold man had right ankle pain just after running a marathon competition Achilles tendinopathy appears as focal or diffuse thickening with a mean thickness of 9 mm a normal tendon measures 5 to 7 mm and a loss of anterior concavity in the transverse plane 23 Achilles paratendinopathy usually reveals diffuse edema around the Achilles tendon Fig 6C D Small fluid collection can be seen in the retrocalcaneal bursa Partial and complete Achilles tendon ruptures are caused by acute muscle strain resulting from sudden or forceful dorsiflexion The diagnosis of Achilles tendon rupture can depend on the patients history and physical examination Nevertheless the initial diagnosis is missed in over 20 of cases 24 On US a focal defect with anechoic or hyperechoic hematoma can be seen and the affected site is usually 26 cm from the calcaneal insertion site Fig 7 Therefore the Achilles tendon should be scanned carefully from its calcaneal insertion to its myotendinous junction Fig 7 Fullthickness tear of the Achilles tendon A Sagittal magnetic resonance image of the Achilles tendon shows complete disruption of the tendon with two tendon stumps arrows and fluid collection at the gap B C Longaxis ultrasonography of the Achilles tendon shows complete disruption arrowheads of the tendon fibers with two tendon stumps arrows with an irregular and retracted appearance Haglund syndrome was first described in 1928 as retrocalcaneal bursitis associated with an abnormal protuberance of the posterosuperior border of the calcaneus 25 It is caused by tendinosis overuse or the wearing of an illfitting shoe that produces bone enlargement of the posterosuperior aspect of the calcaneus leading to inflammation of the overlying tissues and Achilles tendon 8 This abnormality is characterized by swelling of the superficial and retrocalcaneal bursa Achilles tendinosis and a prominent bursal projection of the calcaneus On US fusiform enlargement and inhomogeneity of the distal Achilles tendon with complex hypoechoic fluid in the retrocalcaneal bursa and thickening of the superficial calcaneal bursa are also present 26 Fig 8 Haglund syndrome of the Achilles tendon A Lateral ankle radiograph shows bony hypertrophy of the posterosuperior aspect of the calcaneus arrowhead haziness in the Kager fat pad asterisk and swelling of the distal Achilles tendon arrow B C Longaxis B and color Doppler C ultrasonography of the distal Achilles tendon shows anechoic fluid collection in the retrocalcaneal bursa asterisks swelling with inhomogeneity in the distal Achilles tendon arrows and increased vascularity of the Achilles tendon Ca calcaneus D In a sagittal fatsuppressed T2weighted magnetic resonance image there is bony hypertrophy of the posterosuperior aspect of the calcaneus arrowhead fluid in the retrocalcaneal bursa and swelling with Achilles tendon xanthomas are painless soft tissue masses occurring most commonly in the distal onethird of the tendon usually bilaterally and symmetrically They are characterized by the localized accumulation of lipidladen macrophages inflammatory cells and giant cells secondary to cholesterol deposition in the tissue On US an Achilles tendon xanthoma has a speckled or reticular appearance and extensive tendon thickening 27 Fig 9 Achilles tendon xanthoma AC Shortaxis A and longaxis B left C right ultrasonography of the Achilles tendon shows a heterogeneously enlarged tendon with convexity in the anterior aspect of the tendon and an internal reticular appearance arrows D A sagittal T2weighted magnetic resonance image shows extensive thickening of the Achilles tendon with convexity of the anterior aspect of tendon and a speckled appearance arrows Go to Pathologies of the Ligament The ligament of the ankle is composed of three ligamentous groups the syndesmotic ligamentous complex the lateral ligamentous complex and the deltoid ligament On longitudinal scans ligaments are welldefined linear structures with a fibrillar appearance that should not exceed 2 mm in thickness 28 Morvan et al 29 suggested a classification system based on US for ligamentous tears that involves three categories mild moderate partial and severe complete In mild acute sprains the ligament may be normal or slightly thickened and its hyperechoic fibrillar structure may be slightly altered In a moderate partial tear there is partial interruption with an anechoic area however the ligament remains tight during dynamic examination In a severe complete ligamentous tear there is complete interruption of fibers with an anechoic or hypoechoic gap and the ligament may be wavy and does not tighten with dynamic stress Figs 10A B 11 13 In chronic tears US reveals thickening of the ligament and ossifications may exist Fig 10D 29 Fig 10 Complete and partial tears of the ATFL A Longaxis ultrasonography of the ATFL shows hypoechoic discontinuity of the ligament compatible with a complete tear arrow B An inversion stress image provides more diagnostic confidence regarding the complete tear arrows C Normal appearance of the ATFL arrowheads is shown D In another patient with lateral ankle pain the ligament exhibits heterogeneous hypoechogenicity with some calcifications This finding reveals a chronic partial tear arrow ATFL anterior talofibular ligament LM lateral malleolus Ta talus Fig 11 Injury of the CFL A Longaxis ultrasonography of the right CFL shows a hypoechoic and wavy appearance arrows The patient had an inversion injury of the ankle 1 day prior B Ultrasonography of the left side with a normal CFL shows a curved course with an echogenic fibrillar structure arrowheads located between the calcaneus and peroneal tendons CFL calcaneofibular ligament PL peroneus longus tendon white asterisk PB peroneus brevis tendon black asterisk Ca calcaneus Fig 12 Complete tear of the deltoid ligament On the longaxis ultrasonography of a 38yearold woman with an eversion injury the deltoid ligament appears swollen with redundant ligament fibers arrows in A and suggests a complete tear when compared with a normal fan shape arrowheads in B of the contralateral deltoid ligament T tibia Ta talus Fig 13 Complete tear of the AiTFL A Longaxis ultrasonography of the AiTFL shows a loss of normal fibrillar continuity with heterogeneous echogenicity arrows This finding reveals a complete tear B Ultrasonography of opposite ankle shows a normal fibrillar appearance arrowheads of the AiTFL compared with a complete tear A C An axial fatsuppressed T2weighted magnetic resonance image shows a disruption of the AiTFL arrow with adjacent soft tissue hyperintensity and bone contusion of posterior malleolus AiTFL anterioinferior tibiofibular ligament F fibula T tibia Anterior Talofibular Ligament The ATFL is the most injured ligament during inversion strains of the ankle followed by the CFL 30 Rupture of the ATFL and CFL together may occur in approximately 20 of injuries 31 The ATFL joins the anterior edge of the tip of the lateral malleolus 3 To examine this ligament a probe is placed in the transverse plane with the most distal aspect of the lateral malleolus in the longitudinal axis of the foot 2 Dynamic tests such as plantar flexion inversion stress or an anterior drawer test may place tension on the ligament The ligament appears as a flattened hyperechoic structure located at the lower part of the lateral articular face of the talar dome Fig 10C Posterior Talofibular Ligament The PTFL is composed of multiple thin bundles separated by fat resembling the anterior cruciate ligament of the knee It is hardly detectable with US because of its deep location 32 Calcaneofibular Ligament The CFL is usually sequentially torn after the ATFL during inversion sprains In contrast an isolated sprain is rare but may occur Complete CFL tears are often accompanied by fluid in the peroneal tendon sheath 14 When suspicious of an injury to the CFL a stress inversion maneuver of the ankle joint and the anterior drawer test should be used to assess the integrity of the ATFL and CFL The CFL originates from the tip of the lateral malleolus therefore it is examined with coronal imaging by placing the upper angle of the transducer over the tip of the lateral malleolus 3 The CFL can be well depicted during dorsiflexion of the ankle on US This ligamentous structure lies deep in the peroneal tendons It has been described as cylindrical and is typically 35 mm thick and 48 mm wide 33 Deltoid Ligament The strong deltoid ligament suffers eversion sprains less commonly than inversion sprains The medial deltoid ligament has a triangular shape originates from the apex of the medial malleolus and fans over the internal aspect of the talus and calcaneus Fig 12 This ligament is best shown during dorsiflexion and eversion stress on the hindfoot due to absence of anisotropy 28 In acute tears of the deltoid ligament the radiologist must look for associated lateral malleolar fractures or distal tibiofibular tears 29 Anteroinferior Tibiofibular Ligament The anteroinferior tibiofibular ligament AiTFL starts from the distal tibia and descends obliquely between the adjacent margins of the tibia and fibula Most commonly injuries of the distal tibiofibular syndesmosis in ankle fractures occur in the AiTFL 838 on arthroscopic findings 34 The AiTFL is the weakest of the syndesmotic ligaments and is the first to yield to forces that create an external rotation of the fibula around its longitudinal axis Fig 13A C The AiTFL sometimes appears striated due to fat interposed between the fascicles of the ligament Fig 13B 8 Go to Pathologies of the Nerve Tarsal Tunnel Syndrome Tarsal tunnel syndrome is an entrapment disorder of the tibial nerve and its branches on the medial side of the ankle The clinical manifestations of tarsal tunnel syndrome include numbness and pain in the toes and the soles of the feet The causes of tarsal tunnel syndrome can be divided into intrinsic and extrinsic factors or a combination thereof Intrinsic factors include spaceoccupying lesions such as a ganglion cyst a lipoma enlarged veins a tumor or a neuroma an osteophyte hypertrophic retinaculum tendinopathy and adhesion or fibrosis secondary to hemorrhage Extrinsic factors include direct trauma foot deformities varus or valgus heel generalized lower limb edema constrictive footwear and systemic inflammatory arthropathy 35 36 In the Japanese literature the causes of tarsal tunnel syndrome are well documented with the ganglion and talocalcaneal coalition being prominent 37 Similarly another study reported that the ganglion and talocalcaneal coalition represented 4050 of the cause of tarsal tunnel syndrome 38 The ganglion is usually depicted as an anechoic or hypoechoic area with a round or multilobular shape Fig 14 Some ganglia are associated with talocalcaneal coalitions 37 If a ganglion is suspected a description of the size location morphology and relationship between the posterior tibial artery and the ganglion is recommended 39 Fig 14 Tarsal tunnel syndrome caused by a ganglion Shortaxis A and longaxis B ultrasonography over the medial malleolus shows the compression of the tibial nerve arrows by a ganglion asterisks in the tarsal tunnel MM medial malleolus To diagnose talocalcaneal coalition radiography is essential to show the bony prominence inferior to the medial malleolus US can also reveal a beakshaped bony process in shortaxis images Fig 15 39 Fig 15 Tarsal tunnel syndrome caused by tarsal coalition A Coronal computed tomography image of both feet demonstrates a fibrous or cartilaginous coalition between the talus and calcaneus arrows B C Longaxis B and shortaxis C ultrasonography of the tibial nerve shows compression arrowhead in B by a bony prominence and swelling of the proximal nerve arrowhead in C The tibial nerve passes through the medial side of the ankle and branches into the medial plantar nerve lateral plantar nerve and medial calcaneal branch This area is called the tarsal tunnel These components are covered by the flexor retinaculum from the medial malleolus of the tibia and slight changes of the calcaneus in this space can easily result in neuropathy Figs 14 15 Dynamic analysis with US can contribute to the diagnosis by revealing small lesions arterial pulsation spaceoccupying lesions and nerves Lipomatosis of the Nerve Lipomatosis of the nerve which is also known as fibrolipomatous hamartoma is a rare benign tumorlike process characterized by infiltration of the epineurium by adipose and fibrous tissues leading to nerve enlargement 40 It has a high prevalence in the upper extremities and most cases involve the median nerve although other nerves can be involved 41 In this condition fatty tissue exists between the nerve fascicles similar to a coaxial cable in the axial plane and a spaghettilike appearance can be observed in the coronal plane Fig 16 42 Fig 16 Lipomatosis of the tibial nerve Shortaxis A and longaxis B ultrasonography over the medial malleolus shows a thickened and enlarged nerve arrows which resembles a thin spaghetti noodle MM medial malleolus TP tibialis posterior tendon FDL flexor digitorum longus tendon Go to Conclusion The differential diagnosis of ankle pain is extensive Ankle disorders can be traumatic inflammatory infectious or degenerative US is the firstline imaging technique used for the detection of lesions in the tendons ligaments and nerves of the ankle Moreover dynamic US with a dorsiflexioneversion maneuver of the ankle may be helpful for the detection of intermittent dislocation and intrasheath subluxation of the peroneal tendons A stress test during US provides diagnostic confidence regarding the differentiation between partial and complete tears of the ligaments To identify ankle lesions more accurately 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20134217511754 Go to TOOLS PubReader ePub Link Full text via DOI Full text via PMC Download Citation CrossRef TDM EMail Share METRICS 4 Crossref 4 Scopus 38173 View 1310 Download

O O B O O O O B O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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BOOK AN APPOINTMENT ONLINE REQUEST AN APPOINTMENT SET UP CORPORATE ACCOUNT Hair Drug and Alcohol Testing Panels available Nationwide Alcohol EtG Testing Hair Follicle Testing Hair follicle testing for drugs of abuse is becoming very popular Hair testing is a process in which hair specimens are analyzed for the use of illicit drugs e7 Health offers hair follicle testing in drug testing facilities across the United States We offer same day or next day appointments and allow you to book your appointments online When compared to other forms of testing hair samples can detect a much longer period of drug use For example urinalysis can only detect most drugs within 23 days of use After this period a donor will be free of the drug test negative and slip through the screening process By comparison the industry standard is to test 15 inches of head hair for approximately 90 days of history This is important in preemployment testing where most candidates are aware that a drug test might be required and can otherwise abstain accordingly Hair follicle drug testing is often required for Court Ordered Drug Testing Child Custody Required Drug Testing Child Protection Required Drug Testing The Benefits of Hair Testing Difficult to cheat Easy collection 90 day drug use history More positives with hair then urine drug testing What drugs are tested with hair testing Quest Diagnostics tests for amphetamines amphetamine methamphetamine MDMA and MDA Ecstasy is reported under the Amphetamines group opiates codeine morphine and 6AM or expanded opiates which includes semisynthetic opiates cocaine marijuana and PCP Our Labcorp facilities offer the following hair testing panels Hair 5 Panel Cocaine Marijuana Phencyclidine Amphetamines including methamphetamines Opiates Hair 5 Panel w Exp Opiates Cocaine Marijuana Phencyclidine Amphetamines including methamphetamines Opiates including heroin codeine morphine hydrocodone hydromorphone Oxycodone Hair 9 Panel Cocaine Marijuana Phencyclidine Amphetamines including methamphetamines Opiates including heroin codeine morphine hydrocodone hydromorphone Oxycodone Propoxyphene Methadone Benzodiazepines Barbiturates Hair 12 Panel Cocaine Marijuana Phencyclidine Amphetamines including methamphetamines Opiates including heroin codeine morphine hydrocodone hydromorphone Oxycodone Propoxyphene Methadone Benzodiazepines Barbiturates Meperidine Tramadol Oxycodone Call e7 Health Today for any information about hair follicle testing or to order a hair follicle test Alcohol EtG Testing Urine or Hair Particular for court ordered alcohol testing EtG is the popular test for alcohol Ethyl Glucuronide EtG is a direct metabolite of beverage alcohol ethanol Its presence in urine may be used to detect recent alcohol consumption even after ethanol is no longer measurable The presence of EtG in urine is a definitive indicator that alcohol was ingested With urine EtG alcohol testing there is about an 80 hour lookback period with hair follicle EtG alcohol testing detection is up to 90 days EtG tests are commonly used for individuals on court ordered probation child custody proceedings and persons in a substance abuse treatment program EtG test results can be sent to the donor or other authorized party such as an attorney probation officer or the court The EtG test properly known as Ethyl Glucuronide is a metabolite produced from drinking alcohol and is used to detect alcohol levels in urine It is being used by courts and probation departments as a way of testing if people are drinking EtG is a reliable indicator of alcohol consumption as the metabolite can be found in urine for up to 80 hours after drinking EtG testing can be a very effective tool in monitoring individual abstinence when used in conjunction with other monitoring techniques such as increased surveillance case manager contact and interviews with family members or employers if EtG alcohol testing is available for court ordered programs probation legal cases divorce child custody and other alcohol monitoring program e7 Health works with many attorneys for EtG alcohol testing with urine or with hair Early recognition of problem drinking or relapse for courtrelated purposes such as criminal justice or child welfare is important to help assure effective treatment and to protect atrisk populations The EtG test is a urine sample test that detects the presence of ethyl glucuronide when someone has consumed alcohol The urine tests are usually given to people who have been courtordered not to drink alcohol or by employers who randomly tests employees to determine if they have been drinking on the job The EtG test is sensitive to even very low levels of alcohol and can detect alcohol in a persons system several days after their last drink The test is so sensitive however that it has been known to give positive results when someone has merely come in contact with alcohol through the use of common household products EtG is not appropriate for workplace drug testing as it does not detect current impairment or prove current consumption of alcohol during hours e7 Healths offer EtG testing in all areas of the United States using Quest Diagnostics are our certified laboratory Call today for immediate EtG alcohol testing Drug Testing for Individuals e7 Health has drug testing centers all over the United States that are able to provide immediate drug and alcohol testing for individuals when the situation requires immediate testing with expedited results Immediate testing means that the testing itself is done sameday or immediately with the results usually reported back the next business day This immediate drug and alcohol testing is available for situations such as probation legal cases court ordered testing divorce custody and other testing where the results are needed immediately Hair testing and EtG alcohol testing available in all area of the United States Call Now for Employer Drug Alcohol Testing One of the most important decisions a business can make is to implement a comprehensive drug testing and drugfree workplace program and policy for their business With the proper drug and alcohol testing program in place as an employer you are protected from liability situations through the drug testing program Employee drug testing is legal in all States but the programs must follow Federal and State laws in order to be compliant We know the different laws in every state and will put together a program and policy for your business that conforms to all federal and state laws that

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PM

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Location

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iTrader

Oil

leak

coming

from

oil

filter

Today

I

was

looking

under

the

hood

just

doing

a

quick

visual

inspection

and

noticed

that

I

have

a

small

leak

coming

from

my

oil

filter

I

tried

to

post

a

pic

but

I

could

not

figure

it

out

Could

I

have

a

bad

sill

could

it

have

been

over

tightened

Any

advise

would

be

much

appreciated

Thanks

Appreciate

Quote

PM

Banned

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Coupe

Join

Date

Mar

Location

Fl

iTrader

Oil

filter

housing

gasket

Easy

fix

Appreciate

Quote

PM

Second

Lieutenant

Rep

Posts

Drives

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Date

Oct

Location

california

iTrader

Yup

easy

fix

and

cheap

part

The

correct

procudure

calls

out

to

remove

the

intake

manifold

but

you

wont

have

to

All

you

have

to

do

is

loosen

the

bolts

that

hold

it

down

to

the

top

of

the

engine

Ohh

and

make

sure

to

replace

the

aluminum

bolts

that

hold

down

the

oil

filter

element

shoot

me

a

PM

if

you

need

help

replacing

it

Appreciate

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AM

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Location

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iTrader

here

is

a

picture

of

what

im

dealing

with

I

just

think

its

the

black

o

ring

gasket

on

the

filter

cap

what

do

you

guys

think

Attached

Images

Appreciate

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Major

General

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Date

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Location

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US

iTrader

I

think

youre

right

May

want

to

change

fix

that

and

youll

get

a

new

filter

to

boot

Appreciate

Quote

AM

Second

Lieutenant

Rep

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Date

Oct

Location

Cherry

Hill

NJ

iTrader

Its

a

little

hard

to

tell

from

that

pic

where

the

oil

is

coming

from

But

Id

just

replace

the

filter

and

the

oring

Its

only

a

couple

of

bucks

and

is

a

piece

of

cake

to

do

Appreciate

Quote

AM

Banned

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Join

Date

Mar

Location

North

JerseyPhillyNYC

iTrader

Garage

List

Its

most

likely

your

oring

Its

easy

to

place

it

in

the

wrong

groove

on

the

oil

filter

cap

You

should

first

try

removing

the

cap

and

seeing

if

the

oring

is

in

he

correct

position

Im

talking

about

the

large

black

oring

in

this

DIY

guide

Appreciate

Quote

PM

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Member

Rep

Posts

Drives

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Join

Date

Sep

Location

washington

iTrader

Thanks

for

the

quick

replies

Do

i

need

to

drain

the

oil

in

order

to

change

the

filter

Will

oil

spew

out

if

I

unscrew

the

black

filter

cap

with

out

draining

the

oil

first

Appreciate

Quote

AM

Banned

Rep

Posts

Drives

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Join

Date

Mar

Location

North

JerseyPhillyNYC

iTrader

Garage

List

No

Im

pretty

sure

youre

suppose

to

take

the

cap

off

first

so

you

can

drain

it

Otherwise

it

is

a

vacuum

The

DIY

should

mention

that

Just

make

sure

you

have

alot

of

paper

towels

ready

Appreciate

Quote

AM

ENINTY

Banned

Rep

Posts

Drives

Sport

Join

Date

Jun

Location

Virginia

iTrader

Quote

Originally

Posted

by

Thanks

for

the

quick

replies

Do

i

need

to

drain

the

oil

in

order

to

change

the

filter

Will

oil

spew

out

if

I

unscrew

the

black

filter

cap

with

out

draining

the

oil

first

You

dont

need

to

drain

the

oil

to

change

the

filter

but

its

never

a

bad

idea

for

a

fresh

oil

change

The

official

procedure

calls

for

removing

the

oil

filter

cap

first

then

opening

the

oil

drain

bolt

second

I

guess

to

allow

release

of

the

slight

vacuum

in

the

engine

block

as

the

oil

drains

out

like

said

I

always

just

open

the

oil

filler

cap

Ive

done

oil

changes

both

ways

and

there

is

always

about

ounces

of

oil

sitting

in

the

oil

filter

housing

regardless

of

the

technique

followed

The

system

must

be

designed

for

Anyway

you

can

open

the

oil

filter

cap

and

remove

the

filter

without

draining

the

oil

from

the

engine

Just

be

slow

about

it

so

you

dont

drip

oil

all

over

the

place

its

best

to

keep

a

rag

handy

to

place

under

and

around

the

oil

filter

element

once

youve

lifted

it

from

the

oil

bath

it

will

be

sitting

in

If

you

havent

done

this

before

there

are

two

Orings

to

replace

a

small

green

one

on

the

base

of

the

filter

cap

stem

and

the

large

black

one

that

seals

the

filter

cap

which

seems

to

be

the

one

you

are

having

issues

with

The

large

Oring

sits

in

a

small

squareshaped

groove

that

is

at

the

base

of

the

oil

filter

cap

It

is

easy

for

the

novice

to

not

properly

seat

the

large

Oring

because

the

threads

for

the

oil

cap

are

quite

large

and

will

accept

the

Oring

if

you

dont

pay

attention

to

what

you

The

oil

filter

element

comes

as

a

kit

with

the

two

new

Orings

mentioned

above

and

a

small

copper

crushwasher

for

the

oil

drain

bolt

If

you

dont

change

the

oil

then

you

will

not

need

the

copper

washer

The

copper

washer

is

not

used

for

replacement

of

the

oil

filter

element

just

making

sure

your

not

confused

about

it

Appreciate

Quote

PM

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Member

Rep

Posts

Drives

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Date

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Location

washington

iTrader

ENINTY

I

switched

out

the

filter

as

well

as

the

two

orings

that

go

along

with

it

It

was

quite

simple

and

fixed

my

leak

problem

I

needed

to

use

a

wrench

on

the

filter

to

get

it

tight

enough

and

I

made

sure

I

lined

up

to

two

green

dots

to

make

sure

it

was

tight

enough

Thanks

to

everyone

for

their

input

Joel

Appreciate

Quote

PM

andywdj

New

Member

Rep

Posts

Drives

Join

Date

Jan

Location

Michigan

iTrader

Just

got

a

used

from

private

party

and

went

to

BMW

dealer

for

an

oil

change

The

dealer

told

me

that

there

is

a

leak

on

the

oil

filter

housing

and

need

to

be

resealed

They

quoted

Any

input

for

this

type

of

service

is

appreciated

I

attached

some

pictures

that

I

took

It

looks

to

me

that

the

seal

need

to

be

replaced

on

the

oil

filter

housing

but

for

dollar

I

am

also

looking

for

an

independent

dealer

around

detroit

area

if

anyone

knows

a

good

dealer

Thanks

Attached

Images

Appreciate

Quote

AM

Captain

Rep

Posts

Drives

Bicycle

Join

Date

Feb

Location

Heaven

on

earth

iTrader

Congrats

on

your

new

BMW

and

welcome

Heres

the

info

below

and

heres

how

to

fix

it

bucks

just

too

expensive

Yours

Bro

Appreciate

Quote

PM

Private

First

Class

Rep

Posts

Drives

Join

Date

Jan

Location

SoCal

iTrader

oil

filter

leak

Hi

I

am

having

the

same

issue

and

want

to

know

where

the

large

Oring

should

go

I

placed

the

Oring

right

above

the

small

threads

half

way

down

from

the

top

cap

When

you

mention

about

the

small

squares

are

you

referring

to

the

slot

right

below

the

top

cap

where

there

are

small

squares

I

did

use

a

screw

driver

to

remove

the

old

ring

which

some

say

may

cause

the

leak

I

checked

around

the

housing

and

didnt

find

anything

unusual

except

the

top

of

the

thread

has

an

inch

gap

where

the

others

have

continues

thread

line

Is

this

normal

Any

picture

of

the

oil

filter

housing

or

suggestion

would

be

appreciated

Quote

Originally

Posted

by

ENINTY

You

dont

need

to

drain

the

oil

to

change

the

filter

but

its

never

a

bad

idea

for

a

fresh

oil

change

The

official

procedure

calls

for

removing

the

oil

filter

cap

first

then

opening

the

oil

drain

bolt

second

I

guess

to

allow

release

of

the

slight

vacuum

in

the

engine

block

as

the

oil

drains

out

like

said

I

always

just

open

the

oil

filler

cap

Ive

done

oil

changes

both

ways

and

there

is

always

about

ounces

of

oil

sitting

in

the

oil

filter

housing

regardless

of

the

technique

followed

The

system

must

be

designed

for

Anyway

you

can

open

the

oil

filter

cap

and

remove

the

filter

without

draining

the

oil

from

the

engine

Just

be

slow

about

it

so

you

dont

drip

oil

all

over

the

place

its

best

to

keep

a

rag

handy

to

place

under

and

around

the

oil

filter

element

once

youve

lifted

it

from

the

oil

bath

it

will

be

sitting

in

If

you

havent

done

this

before

there

are

two

Orings

to

replace

a

small

green

one

on

the

base

of

the

filter

cap

stem

and

the

large

black

one

that

seals

the

filter

cap

which

seems

to

be

the

one

you

are

having

issues

with

The

large

Oring

sits

in

a

small

squareshaped

groove

that

is

at

the

base

of

the

oil

filter

cap

It

is

easy

for

the

novice

to

not

properly

seat

the

large

Oring

because

the

threads

for

the

oil

cap

are

quite

large

and

will

accept

the

Oring

if

you

dont

pay

attention

to

what

you

The

oil

filter

element

comes

as

a

kit

with

the

two

new

Orings

mentioned

above

and

a

small

copper

crushwasher

for

the

oil

drain

bolt

If

you

dont

change

the

oil

then

you

will

not

need

the

copper

washer

The

copper

washer

is

not

used

for

replacement

of

the

oil

filter

element

just

making

sure

your

not

confused

about

it

Appreciate

Quote

AM

ENINTY

Banned

Rep

Posts

Drives

Sport

Join

Date

Jun

Location

Virginia

iTrader

Quote

Originally

Posted

by

Hi

I

am

having

the

same

issue

and

want

to

know

where

the

large

Oring

should

go

I

placed

the

Oring

right

above

the

small

threads

half

way

down

from

the

top

cap

When

you

mention

about

the

small

squares

are

you

referring

to

the

slot

right

below

the

top

cap

where

there

are

small

squares

I

did

use

a

screw

driver

to

remove

the

old

ring

which

some

say

may

cause

the

leak

I

checked

around

the

housing

and

didnt

find

anything

unusual

except

the

top

of

the

thread

has

an

inch

gap

where

the

others

have

continues

thread

line

Is

this

normal

Any

picture

of

the

oil

filter

housing

or

suggestion

would

be

appreciated

The

large

oring

sits

in

the

squareshaped

groove

that

is

in

between

the

top

of

the

threads

and

the

bottom

lip

of

the

cap

Make

sure

you

lubricate

the

oring

with

oil

before

reinstalling

the

cap

Appreciate

Quote

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Is EHS Right For You Admission Process Visiting EHS Affording Eagle Hill International Students Meet the Admission Office Inquiry Form Pioneer Profiles Videos Inquire Now Affording Eagle Hill We understand that the decision to attend boarding school involves a major financial commitment We believe however that the decision to attend Eagle Hill is one that will change the entire trajectory of a childs life Tuition Rates for the 20192020 academic year and 2019 summer session have been established as follows Academic Year 2018 2019 2019 2020 Boarding 77575 79900 Day 55525 57200 Summer Program 2018 2019 10118 10425 In addition each family is required to maintain a separate student spending account for their child The account covers such personal expenses as laundry and dry cleaning weekly allowance weekend activities travel expenses etc The anticipated expenditure per student for the academic year 10 months is 4500 although this number could fluctuate higher or lower depending on the activities in which your child participates The average summer account expenditure is 1000 Financial Aid Eagle Hill Schools financial aid program is based solely on a familys demonstrated need We do not offer scholarships or grants based on merit or athletic ability Eagle Hill has a limited financial aid program and is able to provide some assistance to those parentsguardians who demonstrate clear financial need A familys ability to afford Eagle Hills tuition and their application for financial aid does not influence admission committee decisions in any way After the Admission Committee accepts an applicant to Eagle Hill financial aid awards are made based on a familys demonstrated need and the availability of funds Unfortunately applicants accepted for admission and qualifying on the basis of financial need far outnumber those we can afford to support Although need is the first requirement for financial aid the final selection of a new recipient is based on our evaluation of the students overall academic and personal strengths We can not guarantee funding to all applicants who qualify To help evaluate demonstrated need Eagle Hill subscribes to the nationally standardized system for analysis offered by the School and Student Services SSS for financial aid which is a service of the National Association of Independent Schools NAIS Eagle Hills financial aid program is administered fairly and is consistently applied in accordance with the principles and practice of NAIS and the mission of Eagle Hill School The Parent Financial Statement PFS must be completed by each family who intends to apply for financial aid The PFS is available through SSS NAIS and will accept financial aid applications for the 20192020 st 2018 Eagle Hill does not discriminate in the administration of its financial aid on the basis of race color religion national origin sexual orientation or gender All information relating to applications for financial aid will be held by Eagle Hill in the strictest of confidence and will not be released to any third party Documentation from custodial noncustodial and stepparents will not be shared with other members of the students family How to apply The Financial Aid Application Eagle Hill School utilizes School and Student Services SSS to process our financial aid applications SSS is a service of the National Association of Independent Schools Please go to the online Family Guide to Financial Aid brochure for more information To complete your financial aid application for the coming enrollment year follow these steps Applying For Financial Aid Online To apply go to sssnaisorg and complete the application by February 1 2019 Click on the prompt to begin your Parents Financial Statement PFS Each parent household must complete one PFS You will be given a username and password that will allow you to return to your PFS at a later date before submitting it Your information will be secure Eagle Hill School code 903328 In addition to the PFS we require that you upload the following documents to SSS to complete your financial aid application Signed federal tax return with all supporting schedules from the current year and the previous year Current year W2s from all working parents or IRS Form 1099 or a BusinessFarm Statement if selfemployed by February 1 2019 For questions about the PFS online call SSS at 8003448328 Guaranteed Yearly Eagle Hill School requires that all applicants complete the full financial aid process each year that a student wishes to matriculate at the School Awards are evaluated annually based on the most recent years financial information as well as on the students continued academic effort and good citizenship at Eagle Hill The Committee will review and make adjustments appropriate to changes in financial resources and tuition increases Families should expect to experience an increase in tuition each year however Eagle Hill will make every effort to keep the percentage of financial aid awarded consistent from year to year Unfortunately Eagle Payment Plans At Eagle Hill School we understand the varying financial needs of our families Eagle Hill offers two payment options Plan A Full Payment received on or before July 1 Plan B 50 of tuition received before July 1 and 50 received on or before September 1 In addition there are several institutions that may assist families with financing tuition These companies are not affiliated with Eagle Hill School and should be contacted directly Loan Programs Sallie Mae Online applications only wwwsalliemaecomk12 Your Tuition Solution Inc 2 Park Central Drive Suite 100 Southborough MA 01772 wwwyourtuitionsolutioncom 8009209777 Tuition Income Tax Deduction Payments made for the special education provided at Eagle Hill School may be deductible medical care expenses under the Internal Revenue Code While ordinary education is not medical care the cost of medical care may under certain circumstances include the cost of attending a special school for an individual with a disability if his or her condition is such that the resources of the institution for alleviating such disability are a principal reason for his or her presence there Whether tuition expenses for Eagle Hill will be deductible in a particular case will depend upon the facts and circumstances of each individual students situation There are also percentage limitations applicable to otherwise deductible medical expenses depending on the parents adjusted gross income Therefore before claiming a tax deduction for expenses relating to the special education of a student we highly recommend that you consult with a tax lawyer or accountant about whether your payments to Eagle Hill may qualify for a medical expense tax deduction For more information about tuition fees or financial aid please call Susan Cranford Associate Director of Admission and Director of Financial Aid 14134776000 ext 1213

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


FREE How to Download Music from MySpace in 2018 Myra Updated on Jul 30 2018 to iOS Mac Topics Howto Articles Generally speaking there isnt a direct way for you to download music from MySpace In other words to get MySpace music you will need a tools to help you with it In this blog Ill introduce the method to download MySpace music without any cost or limitations using free tools which is well worth trying The whole process can be divided into two parts Download MySpace Music Video to computer Extract music from the video After following the instructions in these parts you will get MySpace music on your computer successfully If you want to put the music on your iPhone or iPad you can transfer music from computer to iPhoneiPad at no cost Although a little bit complex it seems to be once you are skillful in these operations you will download music from MySpace within minutes Whats more this method is 100 safe and free Read on to get the details Part 1 Download MySpace Music Videos The first step you need to take in downloading music from MySpace is to download the music videos from myspacecom to your computer The free tool you will need in this part is EaseUS MobiMover Free the freeware for video download data transfer and file management Video Download With this feature you can download videos from sites including MySpace YouTube Vimeo Twitter Facebook Instagram Metacafe Break Dailymotion BBC News and more to your computer Mac or PC or mobile device Data Transfer MobiMover supports the data transfer between two iOS devices iPhoneiPad or between an iOS device and computer Music ringtones videos photos contacts messages and more are all transferrable using MobiMover File Management Easily manage iDevice content by deleting editing or adding items from the computer Now lets take a look at how to download MySpace Music to your computer Note To get the URL of the music video you want to extract audio from go to myspacecom Music rightclick the cover or the name of the music youd like to download from MySpace then choose Copy link address Free Download for PC Secure Download Free Download for Mac Secure Download Step 1 Connect an iOS device to your computer and click Trust on your iPhone to trust this computer Then run EaseUS MobiMover Free go to Video Downloader and tap the device icon to choose the device you want to download MySpace videos to Since MobiMover is originally an iOS data transfer tool you need to connect an iDevice to the computer to use its features Step 2 Copy the URL of the MySpace video you want to save to your iPhoneiPad paste it into the bar in MobiMover then tap Download Step 3 After you click the Download button MobiMover will quickly analyze the URL and download the MySpace video to your iPhoneiPad When it has finished you can watch the video on your device TV Library Movies offline whenever you want Now you have successfully downloaded the music video to your computer You are one step away from getting music from MySpace Part 2 Extract MySpace Music from the video When it comes to extracting music from the video two easy ways are recommended If you prefer an online tool go to Method 1 If you have the VLC media player installed on your computer you can get things done with it in Method 2 Method 1Audio Extractor Step 1 Open a browser on your computer and visit audioextractornet Step 2 Click the Open video button and select the video you want to get music from Step 3 Choose a video format according to your needs mp3 wav iPhone ringtone m4a flac ogg mp2 or amr If you choose iPhone ringtone you probably needs to transfer ringtones from computer to iPhone Step 4 Click the Extract audio button to start extracting MySpace music from the video Step 5 When it has finished click Download on the screen to download MySpace music to your computer Method 2VLC Media Player Step 1 Open VLC on your computer and go to Media ConvertSave Step 2 Click the Add button to choose the video you want to extract music from then click the ConvertSave button Step 3 Choose AudioMP3 in the dropdown menu of Profile Step 4 Click Browse in the Destination section to set a storage path for the audio Step 5 Click Start to begin getting music off the video Indirect as it is you can use this way to download music from MySpace for free Besides the tool introduced in Part 1 is also helpful if you want to download videos from MySpace to your computer or iPhoneiPad

O O O O B O B O O O O O O O O O O O O O O O O O O O O O O O O O B O B O O O O O B B O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O O O O O O O O O O B B O O O O B O O O O O O O O O O O O O B B O O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O B O B O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O B O B O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O B O O O O O O O O O O B O O O O O O O O B O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O B O B O O O B B O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O B O B O O O O O O O O O O O O O O O O O O O B O O O O O


Save 5 off orders 50 Apply code ELP18 on cart Expires 1819 Can not be combined About Us Meet the Artist Jason Chan Order Status My Rewards Favorites Wish List Bonsai Trees Classes Workshops Knowledge Center Artist Curated Trees Indoor Bonsai Trees Juniper Bonsai Trees Chinese Elm Bonsai Trees Flowering Tea Trees Ficus Bonsai Trees Maple Bonsai Trees PinesPalms Bonsai Trees Redwood Oak Specialty Bonsai Trees Azalea Bonsai Trees Flowering Bonsai Trees Miniature Garden Trees Bonsai Gift Sets Bonsai Starter Kits Bonsai Tools Meters Bonsai Soil Mix Bonsai Stands Trays Bonsai Pots Bonsai Seeds Kits Bonsai Favors View All Bonsai Trees View all Bonsai Trees Lucky Bamboo Terrariums Air Plants Tillandsias Succulents Money Trees Accessories Events Ikebana Home Lifestyle Tea Pavilion Apothecary Sale Knowledge Base Newsletter SignUp Catalog Request Business Gifts You are here Home Bonsai Trees Bonsai Trees We offer one of the largest selection of bonsai tree species Browse from our collection of professionally trained bonsai trees All bonsai trees are sent directly from our own nursery directly to you Browse all bonsai trees Junipers Junipers are one of the most popular species of trees They are very hardy to both warmer and colder climates and can also be trained very easily View all Juniper Bonsai Satsuki Azaleas For flowering trees the Satsuki Azalea features vibrant colors and deep green foliage Available in a variety of colors including pink coral white purple and red View all Satsuki Azaleas Chinese Elms Chinese Elm bonsai are great for both indoor and outdoor environments They are easily pruned and maintained Great for beginners as well as experienced enthusiasts View all Chinese Elms Bonsai Direct From Nursery Direct from our own nursery Cared for by inhouse artists Packaging Safe and Secure Packaged in our own custom boxes Service Knowledge Were here to help Call us at 18886848377 Knowledge Center Articles Video Basic Branch Wiring Technique Video Repotting your Bonsai Tree Visit our Knowledge Center Bonsai SetsKits Looking for a gift or need all the essentials to get started Our bonsai sets and kits are great for beginners Choose the species that best suits your recipient View all Bonsai SetsKits Bonsai Maintenance Bonsai Soil Mixes Fertilizer Pest Control Trays Turntables Watering Tools Bonsai Books Bonsai Accessories Wire Pliers Rocks Gravel Marbles Figurines Decorative Moss Bonsai Tools Shears Pruners Branch Truck Cutters Rakes Tweezers Moister Meters Bonsai Pots Glazed Pots Unglazed Pots Large Pots Saikei Slabs Sort By Go Page of 16 Chinese Elm The Chinese Elm Bonsai tree is a perfect addition of style and grace to Price 5900 Sale Price 5500 Limited Time Chinese Elm The Chinese Elm Bonsai tree is a perfect addition of style and grace to Price 6900 Rock Juniper Our captivating Rock Juniper Bonsai tree features the power and Price 3500 Sale Price 2900 Trained Rock Juniper For those looking for a more styled bonsai tree the trained rock juniper Price 6900 Large Trained Rock Juniper This version of our trained rock juniper features an older tree Price 13900 Boxwood The Japanese boxwood is a very popular species for bonsai due Price 3900 Miniature Boxwood Since this species needs minimal sunlight the Miniature Boxwood Price 2900 Satsuki Azalea Apple Blossom This flowering bonsai tree produces coral pink blooms that add a refreshing Price 4900 Sale Price 4500 Large Chinese Elm Bonsai Trunk of the Large Chinese Elm Bonsai tree has been trained for years Price 11900 Sale Price 10900 Satsuki Azalea Apple Blossom Starter Kit This starter kit includes all the essential components for maintaining and pruning Price 8500 Sale Price 7500 Golden Gate Ficus This beautiful Golden Gate ficus bonsai tree is actually not as difficult Price 5500 Sale Price 4900 Large Trained Japanese Black Pine Bonsai The thin green needles of the Japanese Black Pine are a greatly sought after characteristic of this pine bonsai Price 13900 Scots Pine Bonsai The thin green needles of the Black Pine are a greatly sought after characteristic of this pine bonsa Price 13900 Miniature Spruce Bonsai The Miniature Spruce is great for a beginner due to its care hardiness Price 2900 Miniature Cedar Bonsai The Cedar bonsai has a mild spicy scented wood that has beautiful Price 2900 Hemlock Bonsai The Tsuga Canadensis or Canadian Hemlock is an evergreen conifer Price 3500 Sale Price 2900 Miniature White Pine Bonsai White Pines or 5needle pines are best known for their needles Price 3500 Sale Price 2900 Organic Blend Bonsai Soil Mix 3 Quart Our best selling bonsai soil mix Bonsai Soil Mix is Ready to Use Provides proper plant support Price 1495 Sale Price 1095 Organic Blend Bonsai Soil Mix 5 Quart Our best selling bonsai soil mix Bonsai Soil Mix is Ready to Use Provides proper plant support Price 2400 Sale Price 1995 Sago Palm This miniature palm bonsai tree Sago can add a tropical feel to any Price 3900 Flowering Tea Tree FujianFukien Tea Fukien Tea Bonsai tree produces tiny white flowers and berries Price 5500 Shohin Flowering Tea Tree This Shohin flowering tea bonsai tree features a thick trunk in a small for Price 3500 Pyracantha Firethorn Bonsai Pyracantha Bonsai tree produces red berries Price 4900 Miniature Upright Mugo Pine Bonsai Mugo Pines are great bonsai trees for a beginner who is interested in a pine bonsai tree Price 3500 Sale Price 2900 Black Pine Bonsai Piney Tim These trees are curated by Jason for their bonsai qualities and potential Each tree has been initially trained ready for individual refinement Perfect for adding your own style and final design with wire and pruning Tree Specifications Width 10 inches Height 13 inches Pot 6 Unglazed Lotus Style Age 8 Price 34900 Silverberry Katy Berry Tree Specifications Height 20 inches Width 19 inches Pot 10 Pot Age 5 Years Price 22900 Oak Oaky Robinson Tree Specifications Height 16 inches Width 14 inches Pot 85 Pot Age 8 Years Price 39900 Silverberry Berry Manilow Tree Specifications Height 20 inches Width 19 inches Pot 10 Pot Age 5 Years Price 18900 Japanese Black Pine Calvin Pine Our artist curated trees are carefully selected by our resident artist Jason Chan Trees undergo regular maintenance throughout the year Tree Specifications Height 11 inches Width 9 inches Pot 5 Pot Age 8 Years Recommended for bonsai enthusiasts experienced in care and maintenance The picture shown above is the actual tree that will ship Tree may arrive with wire due to training Price 39900 Grand Taiwan Ficus Characterized by its trained S shape and soft glossy leaves this ficus bonsai Price 12900 Crepe Myrtle Bonsai Crepe Myrtle Bonsai has beautiful foliage that changes in the fall Price 4500 Kyoto Moss Spores These seed spores produce a beautiful bright green velvety moss Price 695

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O B I O B I O O B I O O O O B I O B I O B I O O O B I O B I O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I B I O O O O O O O O O O O O O O O O O O B I O B I O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


401 West Restaurant eat401west OPENING Spring 2019 Our Mission To champion the hard work of our grower partners build community through food accessibility and encourage celebration of family and friends around the table The Culinary team has been traveling Georgia and Florida to establish farm partnerships and solidify ingredient distribution Our focus is on fresh ingredients and seasonal flavors with some staple favorites of course The 401 experience will be inviting to all provide attentive service and a priceless view of the beautiful downtown waterfront Follow the Journey

B I O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O


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A

MIDDLE

EASTERN

FUSION

GRILL

ABOUT

US

Falafil

Hut

is

a

familyowned

Mediterranean

and

Middle

Eastern

Fusion

Grill

Our

meats

are

certified

Zabihah

Halal

and

are

prepared

according

to

such

observances

We

pride

ourselves

on

serving

you

healthy

wholesome

food

Dinein

or

carry

it

out

Catering

orders

also

available

JUST

A

FEW

OF

OUR

DELICIOUS

ITEMS

WRAPS

Chicken

Shawarma

Beef

Shawarma

Lamb

Shawarma

Falafil

Gyro

Chicken

Kabab

PLATTERS

Chicken

Shawarma

Beef

Shawarma

Lamb

Shawarma

Falafil

Gyro

Chicken

Kabab

COMBINATION

PLATTERS

Chicken

Shawarma

Gyro

Chicken

Shawarma

Lamb

Chicken

Shawarma

Chicken

Kabab

Veggie

Combo

Super

Combo

SPECIALTY

HOT

ITEMS

Chicken

Tawwa

Rice

Beef

Tawwa

Rice

Lamb

Tawwa

Rice

Falafil

Tawwa

Rice

Falafil

pc

Falafil

pc

SALADS

SIDES

Hummus

S

L

Baba

Ghanouj

S

L

Stuffed

Grape

Leaves

S

L

French

Fries

S

L

HUMMUS

WITH

MEAT

Chicken

Hummus

Beef

Hummus

Lamb

Hummus

Chicken

Kabab

Hummus

Falafil

Hummus

LUNCH

SPECIALS

Weekdays

am

to

pm

NonVegetarian

Vegetarian

WE

DELIVER

THROUGH

UBER

EATS

AND

DOORDASH

HOURS

Monday

Closed

TuesdayFriday

am

to

pm

Saturday

pm

to

pm

Sunday

pm

to

pm

LOCATION

W

Golf

Rd

Hoffman

Estates

IL

USA

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O O O O O O O O O O O O B I O O O B I I I I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

mediterranean and middle eastern fusion grill