ULTRASOUND FINDINGS IN ACUTE TENOSYNOVITIS

1.  Dr Arun Gupta
Director imaging
 Dr Rakhee gupta
Dr R K S Gandhi
Dr Vinayak Mittal
Dr Ritesh Mahajan
TENOSYNOVITIS
(ACUTE)

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

3. 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
of
these sheaths is in
intimate contact with
the tendon, and
the two layers are in
continuity with each
other at both
ends and also
occasionally through a
mesotenon.

4. 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 .

5. 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

6. 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 of
the low baseline
vascularity of tendons.

7. Normal appearance of the tendon /
tendon sheath complex of the extensor
compartment of wrist.
Tenosynovitis in the extensor
compartment of the wrist .
Normal / Abnormal

8. 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 diffuse
nodular 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 .

9. TERMINOLOGY
PERITENDINITIS
In peritendinitis the inflammation takes
place in the paratenon, the layer of
connective tissue that wraps
around the tendon in the absence of a
synovial sheath.

10. REFERENCE
DIAGNOSTIC
ULTRASOUND
FOURTH EDITION
Carol M. Rumack, MD, FACR
J. William Charboneau, MD, FACR
Deborah Levine, MD, FACR