MSK: Ultrasound

Question 1

Why might these images of the same tendon appear different during the same scanning study?

Answer 1

Anisotropy

Note: In order to evaluate tendons using US you must be exactly perpendicular to the tendon. If you are not perpendicular, then the tendon might appear hypoechoic (i.e. injured) when it is actually fine.

Question 2

Anisotropy makes it especially difficult to evaluate which structures during a shoulder ultrasound?

Answer 2

• Supraspinatus tendon (as it curves along the contours of the humeral head)
• Long head of biceps tendon (in the bicipital groove)

Question 3

Does this tendon appear intact?

Answer 3

Yes

Note: There is a small hypoechoic fluid collection surrounding this tendon (this was a repair after rupture).

Question 4

Answer 4

Supraspinatus tendon tear (partial)

Note: It can be difficult to tell if there is a partial or complete tear on ultrasound.

Question 5

Answer 5

Tenosynovitis

Note: There is abundant fluid within this tendon sheath.

Question 6

Measurement is 5 mm

Answer 6

Plantar fasciitis

Note: Thickening of the plantar fascia greater than 4 mm with loss of the normal fibrillar architecture.

Question 7

Which band is most often affected in plantar fasciitis?

Answer 7

The central band

Question 8

Supraspinatus tendon ultrasound

Answer 8

Calcific tendonitis

Note: Shadowing from calcium hydroxyapatite deposits.

Question 9

What is the most common location for calcific tendonitis?

Answer 9

The supraspinatus tendon