Tendon Hyperechogenicity
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Helpful Clues for Common Diagnoses
Due to deposition of hydroxyapatite crystal within tendon substance
Leads to severe pain and restriction of movement
Tendons around shoulder are most commonly affected
Other less commonly affected tendons are
Focal hyperechoic area of varying size and shape
± acoustic shadowing depending on size
± associated tendinosis (mild, moderate, or severe)
± tendon tear
± pericalcific color flow on Doppler imaging
± intraarticular, intrabursal or intraosseous crystal deposition
Several tendons may be affected simultaneously
Treatment
Dystrophic calcification seen in Achilles tendon > > quadriceps and patellar tendons > posterior tibialis tendon
Affects tendons close to insertional area
Usually associated with background tendinosis
Discrete areas of calcification within tendon from few mm to few cm
Strong posterior acoustic shadowing
Color Doppler flow is feature of tendinosis rather than calcific deposition
Usually associated with reactive bony changes at insertional area
May occur in asymptomatic subjects with no other US features of tendinosis
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