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evaluation:
Tendon – Muscle – Cartilage
and Nerve
Prof. Dr. İsmet TAMER
İstinye University, Faculty of Medicine
Dept.of Family Medicine
Liv Hospital Bahçeşehir
Tendons
Terminology
- Tendinopathy: general umbrella term for pain and swelling of a tendon
- Tendinitis
previously popular term largely replaced by tendinopathy
now largely used to refer to an acute inflammatory process, e.g. calcific tendinitis, rheumatoid
arthritis
- Tendinosis
chronic tendon injury with cellular-level damage
some authors specifically define it as tendinopathy of the mid-tendon
- Tenosynovitis: pain and swelling affecting a fully-developed tendon sheath +/- tendinosis
- Tendon entrapment
- Tendon rupture
- Tendon instability (subluxation and dislocation)
Pathology
Tendon pathology can be “degenerative” or “traumatic”, e.g. acute ruptures, lacerations
Calcific tendinitis
• Calcific tendinitis (or calcific tendonitis) is a self-limiting condition due to the
deposition of calcium hydroxyapatite within tendons, usually of the rotator cuff.
• Typically this condition affects middle-aged patients between the ages of 30 and
60, with a slight predilection for women.
• This condition most frequently affects the rotator cuff of the shoulder including
supraspinatus: 80%,
• infraspinatus: 15%,
• subscapularis: 5%,
• periarticular soft tissues in addition to tendons, ligaments, capsule and bursae.
However, the condition may occur anywhere in the body with the hip and knee
being the other most common locations.
Supraspinatus tendinitis Calcific tendinitis
(Plain X-ray) (Ultasound image)
(Calcific deposits are usually visualized as
homogeneous hyperdensity with variable (a curvilinear/ovoid calcification with acoustic
morphology.) shadowing capsular soft tissue swelling)
Supraspinatus calcific tendinitis Supraspinatus calcific tendinitis
(CT) (MRI)
Α 10-year-old male who sustained a low-grade strain in the rectus femoris muscle, 4 days after an injury that occurred while
playing basketball.
(a) Axial MR image of the anterior thigh demonstrates faint increased signal (arrowhead) in the rectus femoris muscle adjacent
to the thickened myotendinous junction.
(b) Coronal MR image shows hyperintense signal (arrowheads) in the rectus femoris muscle surrounding the thickened
myotendinous junction and tracking along the muscle fascicles, in a feathery pattern (arrow).
Muscle tear
Figure shows: Adductor longus
tear in a 16-year-old male, 2 days
after a bowling injury.