Ultrasound of tendons

The ultrasound method competes with MRI in the diagnosis of tendon pathology. The main advantage of ultrasound is: high spatial resolution when scanning soft tissue structures and the ability to dynamically study in real time.

Technique of ultrasound of tendons.

The choice of the 7.5 MHz frequency of the linear sensor is optimal for the study of almost all tendons. For superficial tendons, it is recommended to use higher frequencies - 12-15 MHz. To begin research it is necessary with identification of a bone structure - areas of an attachment of a tendon. To search for small tendons, the study can begin with cross sections. Tendon images are obtained both in the transverse and longitudinal sections. To compare the results, it is necessary to examine the contralateral side. Some changes in the scanning angle can lead to a change in the echogenicity of the scanned tendon due to the emerging anisotropy effect, so it is important that the test tendon be at an angle of 90 degrees to the ultrasound. Panoramic scanning mode provides visualization of the tendon all over.

Echocardiitis of the tendons is normal.

Tendons consist of long collagen fibers. Around some tendons there is a synovial membrane. Between the tendon and the membrane contains a small amount of synovial fluid, facilitating the sliding of the tendon in the synovial vagina. Such tendons are found in especially mobile joints (wrist, wrist, ankle). The presence of such a shell makes it possible to conduct a good ultrasound evaluation of the tendon. For example, in the study of the shoulder, the tendon of the long head of the biceps muscle is well differentiated, which is surrounded by the synovial membrane. Tendons without a synovial membrane are more difficult to investigate using the ultrasound method. They are surrounded by a connective tissue - a paratenon and tendon bags (bursa) always form in the place of their attachment. With the help of the ultrasound method, large tendons can be studied: Achilles, plantar, proximal gastrocnemius and semimembrane. While smaller tendons are difficult for ultrasound. With longitudinal ultrasound scanning, tendons look like linear fibrillar, alternating between themselves, hyper- and hypoechoic structures. The mode of the tissue harmonics more clearly traces out the contours and fibrous structure of the tendons. Tendons with a synovial membrane are surrounded by a hypoechoic "halo," which normally contains a small amount of fluid. Tendons that do not have a synovial membrane are surrounded by a hyperechoic connective tissue that forms a near-sucking space.

The course of the tendon fibers in the attachment area is not always perpendicular to the ultrasound and therefore, due to the emerging anisotropy effect, this zone looks hypoechoic. In transverse scanning, some tendons have a rounded shape, for example, a tendon of a long biceps head or an oval-shaped Achilles tendon. As well as a square - plantar tendon. In MP-tomograms, tendons in T1 and T2-weighted images have a low intensity.

Ultrasound signs of pathology of tendons.

Stretches or tears occur more often at the point of the tendon transition into the muscle or at the point of attachment of the tendon to the bone.

Stretching. When stretching, there is no violation of the integrity of the tendon fibers. However, at the point of stretching, the tendon can be thickened by swelling. When palpation is determined by local soreness, with passive tension - a sharp pain. Discomfort when moving in the joint. Often, in response to stretching, muscle spasm develops. Treatment consists in restriction of mobility and load, in some cases - immobilization; painkillers, muscle relaxants and anti-inflammatory drugs are used.

Partial rupture of tendons. At partial discontinuities, incomplete violation of the integrity of the tendon fibers with a significant loss of the function of the corresponding muscle is noted. The echographic pattern depends on the type of tendon and the presence or absence of the synovial membrane.

Tendons with a synovial membrane. The tendon of the long biceps head is most often damaged. Predisposing factors are tendinitis of the rotator cuff and inflammation of the tendon of the long biceps head. At the site of the rupture, a partial disturbance of the fibrillar structure of the tendon is observed with the formation of an anechoic defect, the synovial effusion around the damaged tendon.

Tendons without synovium. Partial rupture of tendons that do not have a synovial membrane leads to local thickening of the tendon with violation of the contours of the tendon and fibrillar structure at the site of the defect. The place of rupture is filled with a liquid or fatty tissue. The approach to treatment is differentiated, depending on the type of tendon, the degree of its significance and activity. Long-term immobilization is recommended.

Full rupture of tendons. A complete rupture of the tendon is accompanied by a complete loss of the function of the corresponding muscle and a complete violation of the integrity of the fibers with retraction of the proximal part, which is manifested by local swelling on the surface and by occlusion at the point of rupture. Treatment consists in the urgent restoration of the integrity of the tendon.

Tendons with a synovial membrane. At full rupture, the fibrillar structure of the tendon is broken, the tendon fibers are completely absent at the site of the rupture. The tendon sheath at the place of rupture is filled with a hypoechoic synovial fluid and blood that surround the shortened fibers of the ruptured tendon in the distal sections.

Tendons without synovium. The ruptured ends of tendons that do not have a synovial membrane contract, their fibrillar structure is completely disturbed, the defect is filled with blood upon rupture of the rotator cuff or fatty tissue when the Achilles tendon ruptures.

Treatment consists in the urgent restoration of the integrity of the tendon, before the development of spasm and shortening of the tendon-muscular part. After surgical correction immobilization is carried out. The most typical and frequent damage is considered to be ruptures of the tendon of the rotator cuff and Achilles tendon.

Acute tendonitis and tenosynovitis.

Tendons with a synovial membrane. Tendons with a synovial membrane can thicken, but their echogenicity does not change. Tendinitis is accompanied, as a rule, by tenosynovitis - an increase in the amount of synovial fluid surrounding the tendon. Fluid in the tendon sheath is better detected on the transverse sections, since the compression of the tendon during longitudinal scanning can displace the synovial fluid in the lateral sections. In the energy mapping mode, an increase in the number of vessels along the fibers of the inflamed tendon occurs. Ultrasound can help visualize the tendon when injecting corticosteroids into the synovial vagina.

Tendons without synovium. Tendons without a synovial membrane with acute tendonitis look thickened, their echogenicity decreases focal or diffusely. Contours can be fuzzy. Ehostruktura non-uniform, with the presence of small gipoehogennyh sites, simulating microfractures. The blood flow along the tendon fibers in the acute phase increases dramatically. Tendinitis in the place of attaching the tendons to the bone is one of the most frequent pathologies. The most typical include: "tennis elbow," "knee jumper," "elbow golfer." Correspondingly, the tendon of the radial extensor of the wrist, the tendon of the patella, the flexor tendon of the wrist.

Chronic tendonitis.

Tendons with a synovial membrane. In chronic tendonitis, as a rule, there is a thickening of the synovium, which can be both hypo-and hyperechoic. In the tendon vagina there may be a small amount of fluid.

Tendons without synovium. Tendons without a synovial membrane appear to be thickened, as a rule, of an inhomogeneous echostructure. Calcinates can appear at the attachment point of the tendon, which also occur along the tendon fibers. Calcifications often occur in the tendons of the rotator cuff, tendon of the patella, Achilles tendon.

Calcific tendonitis.

Metabolic and systemic diseases can induce the development of calcifying tendinitis. It often occurs in the tendons of the upper limb. Echographically, the appearance of small hyperechoic point inclusions along the tendon fibers, which may also appear thickened.

Subluxation of the tendon.

Subluxation of the tendon of the long biceps head - a rare finding is simple for diagnosis in ultrasound.

The absence of a tendon in the interculmonary sulcus is easily detected by transverse scanning in the neutral position of the shoulder. The tendon shifts under the tendon of the subscapular muscle. Subluxation accompanies breaks of the rotator cuff most often. This pathology best manifests itself in a study from the position for evaluating the tendon of the subscapular muscle. The subfertility of the peroneal tendons is most often associated with chronic ankle injury in athletes, football players, gymnasts, dancers. Passive flexion of the foot and turning it to the inside provokes the tendon subluxation. Typically, this is due to tearing or tearing of the retainer of the lateral group of the peroneal tendons.

Cysts of the ganglia.

One of the frequent pathologies of the synovial membrane of the tendons is a hernial-like bulging due to a defect in the fibrous membrane of the tendon. In most cases, there are ganglia on the hands. The formed ganglion on the tendon is filled with the fluid produced by the synovial membrane. Due to this ganglia can increase in volume. A characteristic ultrasound sign of the ganglion is the direct connection with the tendon. Ganglions are oval or round in shape, encapsulated. The contents can have a different consistency depending on the prescription of the disease. Treatment consists in excision of ganglia.