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Tendinitis And Tenosynovitis - A Pictorial Essay.
AT KHARAT, A SINGH, P RANGANATH, VM KULKARNI
Ind J Radiol Imag 2006 16:2:235-237
Keywords: USG, Tendons, Tendinitis, Tenosynovitis
INTRODUCTION: PICTORIAL PRESENTATION OF CASES:
High resolution ultrasound of the tendons has become a A pictorial presentation of few of the characteristic cases
very rewarding technique to diagnose common and is presented.
uncommon disorders of these structures. Due to the
superficial location of the majority of the tendons, they
are easily approached by the transducer. Further
ultrasound guided biopsy can be done if necessary.
Comparative study with normal side, dynamic scanning
and graded compression technique can be used to provide
additional information. This technique is however limited
by presence of artifacts like tendon anisotropy.
MATERIALS AND METHODS:
This was a retrospective study of 40 cases, done at Dr
D.Y. Patil Hospital, Medical College and Research Centre,
Pimpri.
Ultrasound scanner used was GE Logiq 400 PRO Series
with 11 MHz linear transducer.
Figure 2: CHRONIC BICEPS TENOSYNOVITIS
- Echogenic fluid surrounds the biceps tendon in the short axis
view. This can be easily missed unless carefully examined. It is
usually as a result of chronic tendinitis or hemorrhage.
Figure 1
ACUTE BICEPS TENOSYNOVITIS Figure 3: NON - CALCIFIC DEGENERATIVE SUPRASPINATUS
- Image shows a short and long axis image of the biceps TENDONITIS WITH TEAR.
tendon with a halo of anechoic fluid surrounding the biceps - A thickened, hypoechoic bulky and enlarged supraspinatus
tendon in the bicipital groove. Fluid gravitates into the tendon is seen with a focal central defect bilaterally. This is the
consequence of a compromised bony acromial arch with an
inferior triangular recess. intrasubstance tear.
From the Department of Radio diagnosis., Dr Padm D.Y. Patil Medical College., (Deemed University), Pimpri 18.
Request for Reprints: Dr Amit T Kharat, Flat No 2 Building No 34, Ranakpur Darshan Society, New Alandi Road, Vishrantwadi,
Yerawada Pune - 411006.
Received 20 November 2005; Accepted 17 April 2006
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236 AT Kharat et al IJRI, 16:2, May 2006
Figure 4
CALCIFIC SUPRASPINATUS TENDONITIS
- Bright echogenic focus in the belly of supraspinatus
with posterior acoustic shadowing. This occurs usually
as a result of chronic rotator cuff injury -mostly
occupational. Radiograph of the shoulder AP view shows
the calcification.
Figure 7
POSTERIOR TIBIAL TENDON TENOSYNOVITIS
- Short axis view shows an anechoic collection of a rim
of fluid surrounding the posterior tibial tendon as it courses
around the medial malleolus.
Figure 5
PATELLAR TENDINITIS [ligamentum patellae tendinitis]
Figure 8
- Grossly enlarged ligamentum patellae in its entire
PERONEAL TENDON TENOSYNOVITIS
length on the sagittal long axis view. Findings were
- Both the peroneus longus and brevis tendons run in a
confirmed on the T1W sagittal MR image on the left side
single sheath in the lateral compartment of the leg.
of the image.
Tenosynovitis is seen as a collection around the single
sheath on the short and long axis image of this tendon.
Figure 9
Figure 6 FLEXOR TENDON WRIST TENOSYNOVITIS- post
ACHILLES TENDONITIS tubercular
- Thickened hypoechoic bulky tendoachilles with - Flexor tendons of the wrist seen bathed by fluid. The
adjacent peripheral hypoechoic rim on the long axis and tendons are seen floating in the fluid which shows evidence
short axis view. of internal echoes and grain like appearance.
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IJRI, 16:2, May 2006 Tendinitis and Tenosynovitis 237
Acute tendonitis is detected by increased fluid within the
synovial sheath. This increased fluid is seen as an
anechoic halo around the tendon on transverse scans.
Chronic tendinitis is seen as thickening of the tendon
itself without increase in the synovial fluid. Comparison
with opposite side is essential to make a diagnosis of
chronic tendonitis [1, 4, 5].
Tenosynovitis is inflammation of tendon sheaths. It can
be caused by trauma, pyogenic infection or rheumatoid
arthritis [6].
Figure 10
EXTENSOR TENDON TENOSYNOVITIS- WRIST Ganglia are the most common swelling in the hand. These
- Known case of rheumatoid arthritis showing collection are cystic lesions arising from synovial lining of joint or
around the extensor tendons of the wrist with nodular tendon sheath [7].
synovial thickening on the long axis and short axis view
of the extensor tendons. References
1. Dillehay Y, et al: the ultrasound characterization of
tendons, invest radiol 19: 338-341, 1984
2. Von holsbeek MT, Introcaso JH. Musculoskeletal USG
Mosby, 2001, 2 nd edition.
3. Fornage B: Achilles tendon: US examination, Radiology
159; 759-182, 1986.
4. Bruce RK, Hale TL, Gilbert SK: Ultrasonographic
evaluation of ruptured Achilles tendon. J Am Pediatr Med
Assoc 72:15-17, 1985.
5. Crass JR, et al: Ultrasonography of the rotator cuff:
Figure 11 Surgical correlation. J Clin Ultrasound 12:487-491, 1984.
GANGLION CYST 6. Fornage BD, hand and wrist. Musculoskeletal ultrasound
- A ganglion cyst seen arising from the tendon sheath Churchill Livingstone: 151- 179.
7. Nelson CL Sawmiller S, Phalen GS. Ganglion of the wrist
of flexor carpi ulnaris
and hand, J bone joint Surg 1972; 54A: 1459.
DISCUSSION:
Tendons are composed largely of parallel running fascicles
of collagen fibers that inter weave and inter connect [1].
On ultrasound tendons are seen to be echogenic with a
characteristic fibrillary echotexture [2]. Surrounding the
tendon is either an epitendineum or a synovial sheath.
The synovial sheath contains a thin film of fluid that serves
as a lubricant to tendons. Without a synovial sheath, the
epitendineum, a dense connective tissue layer, is tightly
bound to the tendon. Sonographically the epitendineum
is seen as a reflective line surrounding the tendon. [3]
238
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