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European Radiology

, 19:144 | Cite as

“Tenomalacia”: a new sonographic sign of tendinopathy?

  • Viviane Khoury
  • Étienne Cardinal
Musculoskeletal

Abstract

The purpose of this study was to assess tendon compressibility with sonography in extensor tendinopathy and in asymptomatic extensor tendons of the elbow. Sonography of both elbows was performed in eight patients with a clinical diagnosis of unilateral lateral epicondylitis. Tendons were assessed for compressibility by measuring their thickness before and after compression with the transducer. The same manoeuvre was performed while tendon vascularity was assessed with colour Doppler. All eight cases showed increased compressibility of the common extensor tendon on the painful side compared to the asymptomatic side, as well as increased vascularity with compressible vessels on colour Doppler. Other signs of tendinopathy were hypoechogenicity (n = 8), loss of fibrillar pattern (n = 8), intratendinous calcifications (n = 1), partial tears (n = 3), and enthesophytes (n = 5). Increased tendon compressibility indicative of tendon softening or “tenomalacia” is a new sonographic sign of common extensor tendinopathy.

Keywords

Sonography Tendinopathy Epicondylitis Dynamic sonography Tendon softening 

Supplementary material

Video 1

Coronal sonogram of common extensor tendon of the elbow. With graded transducer compression, there is reduction in the tendon thickness (arrows) (AVI 1.05 MB)

Video 2

Coronal sonogram shows common extensor tendinopathy with a small focal hypoechoic intrasubstance tear (hypoechoic region on left of image). With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the tear also show a reduction in thickness (AVI 1.18 MB)

Video 3

Coronal sonogram shows tendinopathy of common extensor tendon with hypervascularity. With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the vessels also show compressibility (AVI 1.60 MB)

References

  1. 1.
    Fornage BD, Rifkin MD (1988) Ultrasound examination of tendons. Radiol Clin North Am 26:87–107PubMedGoogle Scholar
  2. 2.
    van Holsbeek M, Intracaso J (1991) Musculoskeletal ultrasound. Mosby Yearbook, St-Louis, pp 57–90Google Scholar
  3. 3.
    Levin D, Nazarian LN, Miller TT et al (2005) Lateral epicondylitis of the elbow: US findings. Radiology 237:230–234PubMedCrossRefGoogle Scholar
  4. 4.
    Connell D, Burke F, Coombes P et al (2001) Sonographic examination of lateral epicondylitis. AJR Am J Roentgenol 176:777–782PubMedGoogle Scholar
  5. 5.
    Newman JS, Adler RS (1998) Power Doppler Sonography: Applications in Musculoskeletal Imaging. Semin Musculoskelet Radiol 2:331–340PubMedCrossRefGoogle Scholar
  6. 6.
    Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M (1999) Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 27:393–408PubMedCrossRefGoogle Scholar
  7. 7.
    Khoury V, Cardinal E (2007) Dynamic sonography of joints and soft tisúes. Ultrasound Clinics 2(4):699–709CrossRefGoogle Scholar
  8. 8.
    Su BW, Protopsaltis TS, Koff MF, Chang BA, Strauch RJ, Crow SA, Rosenwasser MP (2005) The biomechanical analysis of a tendon fixation device for flexor tendon repair. J Hand Surg (A) 30:237–245CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  1. 1.Department of RadiologyMcGill University Health CenterMontrealCanada
  2. 2.Department of Radiology Hôpital St-LucCentre Hospitalier de l’Université de MontréalMontrealCanada

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