TENDON AND NERVE SONOGRAPHY

https://doi.org/10.1016/S0033-8389(05)70124-XGet rights and content

Tendons and nerves represent probably two of the best applications of musculoskeletal ultrasound (US) due to the high lesion detection rate and diagnostic accuracy of US combined with its low cost, wide availability, and ease of use.34, 51, 79 Development of high-frequency broadband transducers, ranging from 5 MHz up to 15 MHz and more, sophisticated focusing in the near field, and sensitive color and power Doppler technology in progress have improved the ability of US to detect fine textural abnormalities of these structures as well as to identify a variety of pathologic conditions.

This article provides the reader with a basic introduction into the normal US characteristics of tendons and nerves, followed by a review of the more commonly encountered abnormalities of these tissues in many accepted clinical applications of musculoskeletal US.

Section snippets

Anatomic Considerations

Tendons form an integral part of the musculotendinous unit, transmitting the tensions generated in muscles to bone.59 The main histologic component of tendons, accounting for approximately 85% of their dry weight, is type I collagen. In tendons, collagen has a complex arrangement, made of highly ordered bundles of fibers grouped to fascicles. Most fibers have a course longitudinal to the tendon axis; some of them, however, may assume transverse and spiral arrangements.20 Collagen bundles are

Anatomic Considerations and Congenital Anomalies

Nerves are round or flattened cords, with a complex internal structure resembling a cable. They are formed of nervous fibers—composed of axons, myelin sheaths, and Schwann cells—grouped in fascicles. The size and number of fascicles included in a nerve depend on individual nerve, distance from site of origin, and amount of pressure the nerve is subjected to. Fascicles are protected and strengthened by a series of connective tissue coverings. Individual fibers are invested by the endoneurium;

References (81)

  • G.M. Lawson et al.

    The histopathology of fibrous flexor sheath ganglia

    J Hand Surg [Br]

    (1994)
  • K. Nakamichi et al.

    Restricted motion of the median nerve in carpal tunnel syndrome

    J Hand Surg [Br]

    (1995)
  • A. Neuhold et al.

    Degenerative Achilles tendon disease: Assessment by magnetic resonance and ultrasonography

    Eur J Radiol

    (1992)
  • M. O'Brien

    Functional anatomy and physiology of tendons

    Clin Sports Med

    (1992)
  • N. Prato et al.

    Sonographic diagnosis of biceps tendon dislocation

    Clin Radiol

    (1996)
  • E. Silvestri et al.

    Case report: US detection of tendinous metastasis from malignant melanoma

    Clin Radiol

    (1994)
  • G.A. Sobiesk et al.

    Sonographic evaluation of interdigital neuromas

    J Foot Ankle Surg

    (1997)
  • M. Bertolotto et al.

    High resolution ultrasound anatomy of normal Achilles tendon

    Br J Radiol

    (1995)
  • S. Bianchi et al.

    Sonographic evaluation of tears of the gastrocnemius medial head (“Tennis leg”)

    J Ultrasound Med

    (1998)
  • S. Bianchi et al.

    Diagnosis of tears of the quadriceps tendon of the knee: Value of sonography

    AJR Am J Roentgenol

    (1994)
  • S. Bianchi et al.

    Evaluation of tibialis anterior tendon rupture by ultrasonography

    J Clin Ultrasound

    (1994)
  • BreidahlW.H. et al.

    Power Doppler sonography in tenosynovitis: Significance of the peritendineous hypoechoic rim

    J Ultrasound Med

    (1998)
  • W. Buchberger et al.

    Carpal tunnel syndrome: Diagnosis with high-resolution sonography

    AJR Am J Roentgenol

    (1992)
  • W. Buchberger et al.

    High-resolution ultrasonography of the carpal tunnel

    J Ultrasound Med

    (1991)
  • R.O. Bude et al.

    Heterozygous familial hypercholesterolemia: Detection of xanthomas in the Achilles tendon with US

    Radiology

    (1993)
  • R.O. Bude et al.

    Sonographic detection of xanthomas in normal-sized Achilles' tendons of individuals with heterozygous familial hypercholesterolemia

    AJR Am J Roentgenol

    (1998)
  • E. Cardinal et al.

    Power Doppler US in synovitis: Reality or artifact? [letter]

    Radiology

    (1996)
  • P. Chen et al.

    Dynamic high-resolution sonography of the carpal tunnel

    AJR Am J Roentgenol

    (1997)
  • P. Chen et al.

    Nerve territory-oriented macrodactyly: Unusual cause of carpal tunnel syndrome

    J Ultrasound Med

    (1996)
  • Y. Cheung et al.

    Normal anatomy and pathologic conditions of ankle tendons: Current imaging techniques

    Radiographics

    (1992)
  • De FlaviisL. et al.

    Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson diseases of the knee

    Skeletal Radiol

    (1989)
  • De PraL. et al.

    Peripheral nerves

  • S.J. Erickson

    High-resolution imaging of the musculoskeletal system

    Radiology

    (1997)
  • P.U. Farin et al.

    Medial displacement of the biceps brachii tendon: Evaluation with dynamic sonography during maximal external shoulder rotation

    Radiology

    (1995)
  • P.U. Farin et al.

    Rotator cuff calcifications: Treatment with ultrasound-guided percutaneous needle aspiration and lavage

    Skeletal Radiol

    (1996)
  • D.P. Fessel et al.

    US of the ankle: Technique, anatomy, and diagnosis of pathologic conditions

    Radiographics

    (1998)
  • B.D. Fornage

    Peripheral nerves of the extremities: Imaging with US

    Radiology

    (1988)
  • F. Giovagnorio et al.

    Ultrasonographic evaluation of de Quervain's disease

    J Ultrasound Med

    (1997)
  • M. Graif

    Peripheral nerves

  • M. Graif et al.

    Sciatic nerve: Sonographic evaluation and anatomic-pathologic considerations

    Radiology

    (1991)
  • Cited by (154)

    • Past, Present, and Future Considerations for Musculoskeletal Ultrasound

      2016, Physical Medicine and Rehabilitation Clinics of North America
    View all citing articles on Scopus

    Address reprint requests to Carlo Martinoli, MD, Cattedra “R” di Radiologia, Università di Genova, Largo R. Benzi 10, I-16132 Genova, Italy, e-mail: [email protected]

    View full text