Tendonitis Workup

Updated: Dec 21, 2019
  • Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD  more...
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Imaging Studies

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. [4]

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.