Tendon ultrasound – indications and the course of the examination

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As part of the diagnosis of diseases of the musculoskeletal system, imaging examinations, including ultrasound of the tendons, are performed. Ultrasound is useful in assessing the condition of soft tissues, including tendons, as well as ligaments and muscles. The condition of the tendons is assessed, among others, by as part of ultrasound of the Achilles tendon, ankle joint or wrist. What abnormalities can be detected by ultrasound of the tendons?

Ultrasound of tendons in diagnostics of the locomotor system

The tendon is an important part of the muscular system. It is an extension of the muscle and is the link between the muscle and the bone, which is the site of the tendon attachment. Due to this, imaging examinations of the musculoskeletal system are performed Ultrasound of tendons and muscles or magnetic resonance imaging of these structures. It is necessary to choose a method that will allow to assess the condition of the connective tissue that builds tendons and muscle tissue.

Typical indications for an ultrasound of tendons are pain in specific parts of the musculoskeletal system, e.g. wrist, hand, foot or knee. If the doctor suspects a fracture or bone injury, they will first refer the patient to an X-ray or CT scan. In the case of injuries of a different nature, ultrasound is helpful as it reveals pathologies within the tendons, ligaments and muscles.

When suspecting damage and pathology of specific tendons as part of diagnostics, the following are performed:

1. Achilles tendon ultrasound;
2. Ultrasound of the wrist and hand;
3. Knee ultrasound;
4. Ultrasound of the foot and ankle;
5. Shoulder ultrasound (shoulder and shoulder-clavicular joint);
6. Ultrasound of the hip joint;
7. Ultrasound of the elbow joint.

If more detailed imaging of soft tissues is required, instead of (or after) ultrasound, MRI is recommended.

1. Read more about MRI of limbs and joints.

Indications for ultrasound of tendons and adjacent structures

When a patient has disturbing symptoms of the locomotor system, it may be an indication for ultrasound of the problem area. Based on the ultrasound, it can be determined whether the symptoms are the result tendon problems, muscles, ligaments, or other structures within the joints. The following are the indications for ultrasound of the musculoskeletal system:

1. post-traumatic changes and soreness;
2. inflammations;
3. swelling;
4. restriction of joint mobility;
5. hematomas and ecchymoses;
6. tumors;
7. fluid accumulation in the joint;
8. the strain on the limbs in athletes, which results in discomfort and changes in the structures responsible for movement;
9. suspicion of degenerative changes;
10. monitoring the progress of treatment;
11. the need for a biopsy, puncture or injection under ultrasound guidance.

Preparation for ultrasound of tendons

Orthopedists usually refer patients for ultrasound examination of the musculoskeletal system. We will perform such a test free of charge, if a specialist accepts us for an appointment under the National Health Fund. We can also go to a paid ultrasound – then we will not need a referral. The easy availability of ultrasound examinations results from the universality of the appropriate equipment, as well as the safety of this procedure.

Due to the non-invasive nature of ultrasound and the lack of side effects, there is no need to prepare for the examination of tendons, muscles or ligaments. We should only bring the results of previous tests, if any, to the visit. This is true for the previous ultrasound or CT or MRI results.

Ultrasound examination of tendons – course

General procedure tendon ultrasound is similar in each case, with the main difference being the area of ​​the body tested. After entering the office, the doctor conducts an interview with the patient, asks about the symptoms and possible previous tests. Then the area of ​​the body being examined should be exposed; it will be smeared with gel. The specialist will apply the ultrasound head to the prepared skin and move it over the part of the body being examined.

On the screen, you can observe internal structures such as tendons and muscles, as well as pathological changes and exudates. After completing the examination, the doctor will inform the patient about the results, answer questions and prepare ultrasound picture description.

Achilles tendon ultrasound

A special type of imaging examination of the musculoskeletal system is ultrasound of the Achilles tendon, i.e. the largest tendon in the human body. Thanks to the latest ultrasound equipment, it is possible to obtain a high-resolution image. On the basis of this examination, it is possible to analyze the structure of the Achilles tendon, confirm its rupture, assess the degree of damage, and also detect inflammation or fluid in the tendon bursa or under the tendon.

During an ultrasound examination of the Achilles tendon, the doctor may make a notice adhesions in the tendon spaceas well as use them during a follow-up visit and give an opinion on the progress of the treatment so far.

Wrist and hand ultrasound

Ultrasound of the wrist and hand allows for the examination of the tendons responsible for the work of the fingers and wrist muscles – detection of their damage and examination of their mobility in a dynamic examination. Ultrasound is used to diagnose inflammation of the flexor and extensor tendons, crackling fingers or de Querveine’s disease.

Knee ultrasound and tendon injuries

By performing ultrasound of the knee joint, it is possible to assess the condition of the tendons related to the popliteal muscle, gastrocnemius muscle or the muscles stabilizing the knee joint. It can be diagnosed in people suffering from rheumatological diseases tendon ruptures or inflammatory pannus of tendon sheaths or other structures of the knee joint.

1. Find out more: Knee ultrasound – application and course

Ultrasound of the foot and ankle

Assessment of the ankle joint and the tendon structures of the foot based on ultrasound is indicated in the case of acute pain due to trauma or chronic pain, as well as in the case of incomplete foot mobility. Inflammation of the tendons and tendon sheaths is common in the ankle. The causes of inflammation of these structures are not only injuries, but also overload (e.g. due to posture defects) or inflammatory arthropathy.

Shoulder ultrasound

When we perform ultrasound of the shoulder and shoulder-clavicular joints, the doctor will be able to assess the long head tendon, which is an extension of the biceps muscle. The abnormality may include fluid in the tendon sheath. Ultrasound of the shoulder and brachial tendons allows for partial or complete rupture of the tendons. Pain in the shoulder area may also result from damage to the tendons of the rotator cuff.

Ultrasound of the elbow joint

Painful elbow joint is one of the common causes of elbow ultrasound. The symptoms can be acute or chronic. Tendon injuries are rare, but a tendon rupture (for example, biceps brachii) can be caused by a sudden jerk or lifting a heavy load. The source of elbow problems is also inflammation of the tendons in the triceps and biceps muscles. More often, however, pathological changes concern such diseases as tennis elbow, degeneration and bursitis.

1. Find out more about ultrasound of joints – indications and the course of the examination

Ultrasound of the hip joint

The main tendon structure that is examined during ultrasound of the hip is the iliopsoas tendon. Most often, its pathological changes concern athletes practicing athletics, dancers, runners and weightlifters. Other causes of medical conditions include rheumatoid arthritis and osteoarthritis. Of course, during ultrasound of the hip, not only the tendon is analyzed, but also the muscles, ligament apparatus and synovium, the mobility of the joint is also assessed and the presence of exudates is noted.