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“Tenomalacia”: a new sonographic sign of tendinopathy?

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Abstract

The purpose of this study was to assess tendon compressibility with sonography in extensor tendinopathy and in asymptomatic extensor tendons of the elbow. Sonography of both elbows was performed in eight patients with a clinical diagnosis of unilateral lateral epicondylitis. Tendons were assessed for compressibility by measuring their thickness before and after compression with the transducer. The same manoeuvre was performed while tendon vascularity was assessed with colour Doppler. All eight cases showed increased compressibility of the common extensor tendon on the painful side compared to the asymptomatic side, as well as increased vascularity with compressible vessels on colour Doppler. Other signs of tendinopathy were hypoechogenicity (n = 8), loss of fibrillar pattern (n = 8), intratendinous calcifications (n = 1), partial tears (n = 3), and enthesophytes (n = 5). Increased tendon compressibility indicative of tendon softening or “tenomalacia” is a new sonographic sign of common extensor tendinopathy.

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Author information

Correspondence to Viviane Khoury.

Electronic supplementary material

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Coronal sonogram of common extensor tendon of the elbow. With graded transducer compression, there is reduction in the tendon thickness (arrows) (AVI 1.05 MB)

Coronal sonogram shows common extensor tendinopathy with a small focal hypoechoic intrasubstance tear (hypoechoic region on left of image). With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the tear also show a reduction in thickness (AVI 1.18 MB)

Coronal sonogram shows tendinopathy of common extensor tendon with hypervascularity. With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the vessels also show compressibility (AVI 1.60 MB)

Video 1

Coronal sonogram of common extensor tendon of the elbow. With graded transducer compression, there is reduction in the tendon thickness (arrows) (AVI 1.05 MB)

Video 2

Coronal sonogram shows common extensor tendinopathy with a small focal hypoechoic intrasubstance tear (hypoechoic region on left of image). With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the tear also show a reduction in thickness (AVI 1.18 MB)

Video 3

Coronal sonogram shows tendinopathy of common extensor tendon with hypervascularity. With graded compression, there is reduction in tendon thickness. Note that areas of the tendon other than the vessels also show compressibility (AVI 1.60 MB)

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Khoury, V., Cardinal, É. “Tenomalacia”: a new sonographic sign of tendinopathy?. Eur Radiol 19, 144 (2009) doi:10.1007/s00330-008-1112-9

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Keywords

  • Sonography
  • Tendinopathy
  • Epicondylitis
  • Dynamic sonography
  • Tendon softening