Acute tenosynovitis

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ULTRASOUND FINDINGS IN ACUTE TENOSYNOVITIS

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Acute tenosynovitis

  1. 1.  Dr Arun Gupta Director imaging  Dr Rakhee gupta Dr R K S Gandhi Dr Vinayak Mittal Dr Ritesh Mahajan TENOSYNOVITIS (ACUTE)
  2. 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. 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. 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. 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. 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. 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. 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. 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. 10. REFERENCE DIAGNOSTIC ULTRASOUND FOURTH EDITION Carol M. Rumack, MD, FACR J. William Charboneau, MD, FACR Deborah Levine, MD, FACR

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