Sonographic imaging of tendons

Tendons are frequently affected by a wide range of inflammatory, degenerative, and traumatic processes. Their involvement is often oligosymptomatic and underevaluated, because symptoms and signs of tendon disease may be open to variable interpretation. Diagnosis of tenosynovitis and/or tendinitis may be especially challenging in patients with acute or chronic arthritis, because the most common symptom, pain, can be attributed to the underlying joint involvement. The spectrum of pathologic changes includes tenosynovitis, tendinitis, tendinosis, and partial or total tear (1–5). Ultrasonography is a reliable, noninvasive, widely available, and inexpensive imaging technique for assessing soft tissue involvement in rheumatic diseases (6–13). It combines direct multiplanar, tomographic evaluation of the tendons with dynamic investigation of their movement, thus providing both an anatomic and a functional assessment. Ultrasonography is more sensitive than magnetic resonance imaging in the detection of synovitis and tenosynovitis (14). Thus, ultrasonography should be regarded as the “gold standard” for evaluating tendon involvement in rheumatic diseases. Sonographic scanning can be performed during an office visit to the physician; its application in this manner would dramatically change the conventional approach to the evaluation of clinical symptoms in patients with probable or suspected tendon damage (9).