Ultrasonography in the Differential Diagnosis of Achilles Tendon Injuries and Related Disorders

Paavola, Mika; Paakkala, T.; Kannus, Pekka; Järvinen, Markku

doi:10.3109/02841859809175485

Cited by 154 publications

(103 citation statements)

References 15 publications

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“…US is valuable for finding the occurrence and location of tendon lesions, but it is unable to differentiate between partial tendon ruptures and focal degenerative areas (Åström et al, 1996(Åström et al, , Paavola et al, 1998. Sometimes mild to moderate changes can be found in both symptomatic and asymptomatic tendons and the changes that are seen are not always related to patients' symptoms (Paavola et al, 1998, Fredberg and Bolvig, 2002, Peers et al, 2003b. In a prospective study of the value of US and MRI in assessments of Achilles tendon disorders it was found that US identified abnormal morphology in 37 of 57 symptomatic tendons (65%) and normal morphology in 19 of 28 asymptomatic tendons (68%) (Khan et al, 2003b).…”

Section: Imaging Methodsmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Section: Imaging Methodsmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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“…Therefore, baseline US appearance is not able to predict clinical outcome. In Achilles tendinopathy, grey-scale ultrasonography is a costeffective method to examine the Achilles tendon [3,28,33,36]. As grey scale sonography is operator dependent, and relies on the detection of hypoechoic lesion and assessment of tendon thickening and widening, it was hoped that the addition of colour or power Doppler assessment would add objective evidence of pathology.…”

Section: Ultrasoundmentioning

confidence: 99%

Achilles tendon: functional anatomy and novel emerging models of imaging classification

Buono

Chan

Maffulli

2012

International Orthopaedics (SICOT)

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Purpose Ideally, a classification should have some prognostic value, and should therefore include precise information upon extent and location of the Achilles tendon disorders. We propose a new imaging and anatomical system to classify Achilles tendon disorders at imaging using US and MRI. Approach We consider the non-insertional region as the tendon mid-portion, and distinguish the insertional component into a pre-insertion site, located about two centimetres above the calcaneum, and a calcaneal insertion, where the tendon is attached to the bone. On sagittal scans, we introduced a new classification which considers two main portions: "musculotendinous" and "insertional". In the context of the muscolotendinous portion, it is possible to find muscle fibres proximally, and the free tendon distally. This latter is made up of proximal, middle and distal portions. We also propose a 5 grade Doppler classification system to quantify blood flow, in which Grades I and II are respectively characterised by the presence of one and two vessels within the tendon; in Grades III, IV and V, the neovascularisation respectively involves less than 50 %, from 50 to 90 %, and more than 90 % of the tendon tissue. These proposed systems will require validation and possible modification to be applied to different tendons.

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“…Ultrasound shows partial ruptures of the Achilles tendon as wavy irregularities of the fibrillar echo pattern [33]. Focal hypoechogenic areas and thickening of the affected tendon segment are often seen [32]. Alfredson et al reported that the superficial dorsal tendon boundary also has an interruption and accompanying hyperperfusion can be visualized with power Doppler [33].…”

Section: Partial Rupturementioning

confidence: 99%

“…On the whole, the diagnosis of partial ruptures via ultrasound is limited with the differentiation from focal degenerative changes being particularly difficult [32]. Ultrasound shows partial ruptures of the Achilles tendon as wavy irregularities of the fibrillar echo pattern [33].…”

Section: Partial Rupturementioning

confidence: 99%

“…Complete rupture of the Achilles tendon is visualized sonographically as dehiscence of the fibers with a frequently inhomogeneous hypoechoic hematoma between the tendon stumps [32,37]. In the chronic stage, fiber discontinuity occurs with structure resolution which exhibits variable echogenicity depending on the chronicity of the process [38].…”

Section: Complete Rupturementioning

confidence: 99%

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Achillodynia - Radiological Imaging of Acute and Chronic Overuse Injuries of the Achilles Tendon

Syha

Springer

Ketelsen

et al. 2013

Fortschr Röntgenstr

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In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.?g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. Key Points: Citation Format:

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Ultrasonography in the Differential Diagnosis of Achilles Tendon Injuries and Related Disorders

Cited by 154 publications

References 15 publications

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Achilles tendon: functional anatomy and novel emerging models of imaging classification

Achillodynia - Radiological Imaging of Acute and Chronic Overuse Injuries of the Achilles Tendon

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