Tests
1st tests to order
clinical diagnosis
Test
Usually no tests are necessary.
Result
features of tendinopathy
Tests to consider
ultrasound
Test
Quick and inexpensive way to evaluate tendon structure. However, the quality of the ultrasound images is highly operator dependent.[34][35]
Normal tendons appear echogenic. The degenerative tendon may appear thickened and blurred, and may exhibit hypoechoic foci within the tendon.
Result
thickened, blurred tendon, and possible hypoechoic foci within tendon
MRI
Test
Best imaging modality for evaluating some tendon injuries.[34]
Allows for evaluation of surrounding soft tissues.
Normal tendons appear dark whereas degenerative tendons may appear thickened and will exhibit intermediate signal intensity (appears gray/white).[Figure caption and citation for the preceding image starts]: MRI demonstrating mild to moderate tendinopathy of the proximal centimeter of the patellar tendon, characterized by thickening and abnormal signal within the tendonFrom the personal collection of James Wang, PhD [Citation ends].
MRI may not be appropriate for all tendon injuries. For example, avoid routinely ordering MRI in patients with suspected acute Achilles tendon rupture, which is usually a clinical diagnosis.[38][39]
Result
thickened tendon with intermediate signal intensity (gray/white)
x-ray
Test
Plain films do not allow visualization of soft tissues and therefore are rarely used in the diagnosis of tendinopathy.
They are useful as an adjunct to evaluate for bony spurs or malalignment.[40]
Result
calcium deposits may be seen in calcific tendinopathy
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