Ultrasound is a sensitive examination for assessing many tendons of the body. Commonly injured tendons include the rotator cuff tendons of the shoulder and the Achilles tendon.
Imaging of Musculoskeletal Disorders
Tendon disorders
Key points
- Ultrasound is sensitive for assessing tendon disorders
Tendon tear – Achilles tendon
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Tendon tear – Achilles tendon
- The upper image shows the normal structure of a tendon – the Achilles tendon is used as an example
- Ultrasound clearly demonstrates the normal fibre structure of the intact tendon
- The lower image shows a large gap in the tendon fibres
- Because the tendon is under tension, when it ruptures the fibres retract distally and proximally to form a gap
- The gap is filled with blood (haematoma) in this acute complete Achilles tendon rupture
Tendinopathy – Achilles tendon
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Tendinopathy – Achilles tendon
- Tendinopathy (also known as tendinosis or tendinitis) results in thickening of the tendon
- The lower image shows an area where Doppler ultrasound has been applied (green box)
- Doppler ultrasound shows pulsating areas of movement (small coloured areas) within the tendon indicating increased blood supply (hypervascularity)
Tenosynovitis - wrist flexor tendons
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Tenosynovitis - wrist flexor tendons
- Ultrasound and Doppler ultrasound show swelling and hypervascularity of soft tissues surrounding the tendons of the wrist indicating severe tenosynovitis – inflammation of the tendon sheath
Bursitis – subacromial-subdeltoid bursa
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Bursitis – subacromial-subdeltoid bursa
- The subacromial-subdeltoid bursa of the shoulder is a normal thin fluid-filled space which allows smooth movement of the rotator cuff tendons under the deltoid muscle and the acromial arch
- This ultrasound image demonstrates a layer of low reflectivity (black) located between the supraspinatus tendon and the deltoid muscle
- The depth of fluid is greater than normal – the deltoid muscle should contact the superior surface of the supraspinatus tendon
- Excess fluid in the subacromial-subdeltoid bursa is associated with rotator cuff tears (allowing fluid to pass from the glenohumeral joint into the subacromial bursa) or with bursitis – inflammation of the bursa