Imaging of Musculoskeletal Disorders
Tendon disorders

Key points

  • Ultrasound is sensitive for assessing tendon disorders

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.

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

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Page edited by: Dr Richard Smith BSc MSc MBBS FRCP PGDip - Consultant Rheumatologist (Read bio)

Last reviewed: January 2020