Dr Arun Gupta Director imaging

Dr Rakhee gupta Dr R K S Gandhi Dr Vinayak Mittal Dr Ritesh Mahajan

TENOSYNOVITIS(ACUTE)

TENOSYNOVITIS

Tenosynovitis is defined as the inflammation of a tendonsheath. Any tendon surrounded by a synovial sheath—especially tendons in the hand, wrist, and ankle—can beaffected. Trauma, including repetitive microtrauma, andpyogenic infection are most often responsible for acutetenosynovitis. Suppurative tenosynovitis is seen as Debris in fluid in the tendon sheath .

Normal tendons have fibrillar echotexture .

Tendon sheaths per se are imperceptible if not inflammed

Synovial sheaths are double-walled tubular

structures that surround some tendons:

the inner wall ofthese sheaths is in

intimate contact with the tendon, and

the two layers are in continuity with each

other at bothends and also

occasionally through a mesotenon.

TENOSYNOVITIS

USG FINDINGS

• Thickening of the tendon sheaths

• Fluid distending the tendon sheaths

Axial and sagittal view demonstrates the thick tendon sheath lining with fluid distending the space between

the tendons and sheaths .

Increased thickness of the tendon sheath .

The tendons have normal fibrillary echopattern . The

scanned bones have normal cortical outline.

TENOSYNOVITIS .

AXIAL PLANE AXIAL AND LONGITUDINAL PLANE

POWER DOPPLER IMAGING SIGNIFICANT INCREASE IN THE VASCULARITY IS APPRECIATED IN

THE DISTENDED SPACE BETWEEN THE TENDONS AND SHEATHS .

THIS IS SUPPORTIVE OF ACUTE COMPONENT OF THE TENOSYNOVITIS.

INTERVAL IMAGING CAN HELP TO ASSESS TREATMENT RESPONSE ALSO

Power Doppler imaging is

preferred because of its

greater sensitivity in flow detection, especially in light

ofthe low baseline

vascularity of tendons.

Normal appearance of the tendon / tendon sheath complex of the

extensor compartment of wrist.

Tenosynovitis in the extensor compartment of

the wrist .

Normal / Abnormal

TERMINOLOGY

TENDINOSIS Degenerative

changes in a tendon without clinical or histopathologic

signs of inflammation within the tendon

or paratenon.Most often, it is associated with

painful focal or diffusenodular thickening of the tendon.

On power doppler there is increase in the vascularity on

deeper part of the involved tendon.

TENDINITIS Inflammation of the tendon is called as tendinitis . The features of the tendinitis are as : thickening of the tendon , Decreased echogenecity ,

Blurred margins , increased vascularity on color doppler ,

Calcifications are appreciated in chronic tendinitis .

TERMINOLOGY

PERITENDINITIS In peritendinitis the inflammation takes place in the paratenon, the

layer of connective tissue that wrapsaround the tendon in the absence of

a synovial sheath.

REFERENCE

DIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR