- Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD more...
Radiographs may be indicated if a history of trauma is present, but findings usually are negative with tendinopathy.
- Occasionally a fleck of bone may be visualized, suggesting an avulsion fracture at the site of tendinous insertion.
- A roughened appearance of the bone at the site of tendinous insertion may suggest periostitis.
- Calcium deposits along the tendon may be visualized with calcific tendinopathy.
Further imaging studies, such as ultrasonography and magnetic resonance imaging (MRI), are usually reserved for when the diagnosis is unclear or the patient's condition fails to improve with conservative management.
Ultrasonography is a rapid, noninvasive, and portable method to evaluate for tendinopathy.
- On ultrasound images, tendon changes are noted by alterations in tendon morphology and echogenicity. Mucoid degeneration and tendon tearing diminish echogenicity. Calcification can also be appreciated.
- Ultrasonography has been shown to be accurate in evaluating the rotator cuff and Achilles tendon.
- One recent study found that ultrasonography had a greater accuracy than MRI in confirming the clinical diagnosis of patellar tendinopathy.
MRI is also accurate in accessing tendon pathology.
- In the United States, tendinopathy is imaged more often with MRI than with ultrasonography.
- One of the strengths of MRI is that it can also assess cartilage injuries, bony abnormalities, and ligamentous injury, which greatly aids patient management.
Mann KJ, Edwards S, Drinkwater EJ, Bird SP. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy. Med Sci Sports Exerc. 2012 Oct 10. [Medline].
Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15. 71(8):1545-50. [Medline].
Gold L, Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract. 2003 Sep-Oct. 16(5):458-60. [Medline].
Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of Age, Sex, Obesity, and Steroid Use on Quinolone-associated Tendon Disorders. Am J Med. 2012 Sep 28. [Medline].
Harrell RM. Fluoroquinolone-induced tendinopathy: what do we know?. South Med J. 1999 Jun. 92(6):622-5. [Medline].
Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med. 2007 Mar. 35(3):427-36. [Medline].
Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL, et al. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). 2008 Apr. 47(4):467-71. [Medline].
Chesterton LS, Lewis AM, Sim J, Mallen CD, Mason EE, Hay EM, et al. Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial). BMJ. 2013 Sep 2. 347:f5160. [Medline]. [Full Text].
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010 Nov 20. 376(9754):1751-67. [Medline].
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6. 309(5):461-9. [Medline]. [Full Text].
Gatt DL, Charalambous CP. Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including 908 Patients. Arthroscopy. 2014 Sep. 30(9):1166-1172. [Medline].
de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013 Jul. 41(7):1665-73. [Medline].
Abate M, Schiavone C, Salini V. Usefulness of Rehabilitation in Patients with Rotator Cuff Calcific Tendinopathy after Ultrasound-Guided Percutaneous Treatment. Med Princ Pract. 2014 Sep 6. [Medline].
Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014 Oct. 23(10):1527-31. [Medline].
Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2013 Dec 23. 12:CD010071. [Medline].
Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. 2005 Jul. 43(4):771-807, ix. [Medline].
Biundo JJ Jr, Mipro RC Jr, Fahey P. Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 1997 Mar. 9(2):151-4. [Medline].
Biundo JJ, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2001 Mar. 13(2):146-9. [Medline].
Crawford JO, Laiou E. Conservative treatment of work-related upper limb disorders: a review. Occup Med (Lond). 2007 Jan. 57(1):4-17. [Medline].
Garrick JG, Webb DR. Sports Injuries: Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1990.
Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Orthop Clin North Am. 1996 Oct. 27(4):679-709. [Medline].
McLoughlin RF, Raber EL, Vellet AD, et al. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification. Radiology. 1995 Dec. 197(3):843-8. [Medline].
Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005. 87-A:187-202. [Medline].
Sorosky B, Press J, Plastaras C, Rittenberg J. The practical management of Achilles tendinopathy. Clin J Sport Med. 2004 Jan. 14(1):40-4. [Medline].
Tytherleigh-Strong G, Hirahara A, Miniaci A. Rotator cuff disease. Curr Opin Rheumatol. 2001 Mar. 13(2):135-45. [Medline].
van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007 May 26. 369(9575):1815-22. [Medline].
Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. 2006 Feb. 443:320-32. [Medline].
Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician. 2005 Sep 1. 72(5):811-8. [Medline].