tendon pathology

tendonitis

• inflammation of a tendon

• can be diffuse or focal

tendonitis may be caused by:

overuse or strain

fluid within the sheath is often indicative of:

tendosynovitis

clinical findings of tendonitis:

• pain

• painful region may be swollen

• painful region may be warm to touch

sonographic findings of tendonitis:

• diffuse: enlarged, hypoechoic tendon

• focal: localized, enlarged hypoechoic area within the tendon

• fluid may be noted

• hyperemic flow may be noted

tendon rupture/tear

• most likely results from some manner of recreational sport

• can be partial or complete

clinical findings of a tendon rupture:

• pain

• edema

• audible snap may be heard

sonographic findings of a partial tendon rupture/tear:

appear as focal hypoechoic areas within the tendon

sonographic findings of a complete tendon rupture/tear:

• seen as an anechoic or heterogeneous area within the tendon, often indicative of a hematoma

• may also be sonographically identified as refractive shadowing in the area of the separated tendon, with fat, a hematoma, or granulomatous material filling in the gap created by the tear

achilles tendon/calcaneal tendon

the most commonly injured ankle tendon

where is the achilles tendon located and what structures does it connect?

located along the posterior ankle and connects the calf muscle (gastrocnemius) to the posterior surface of the heel, or calcaneus

how should the patient be positioned when scanning the achilles tendon?

the patient lies prone, with their feet hanging off the end of the bed

Thompson test

• conducted with the patient prone as well and can be performed before the sonographic examination

• the calf is squeezed and the foot should plantarflex in a patient who does not have a complete tear of the achilles tendon

clinical findings of an achilles tendon rupture:

• audible snap may be heard

• posterior ankle and leg pain

• positive Thompson test

sonographic findings of a partial achilles tendon rupture/tear:

appear as focal hypoechoic areas within the tendon

sonographic findings of a complete achilles tendon rupture/tear:

• seen as an anechoic or heterogeneous area within the tendon, often indicative of a hematoma

• may also be sonographically identified as refractive shadowing in the area of the separated tendon, with fat, a hematoma, or granulomatous material filling in the gap created by the tear