Imaging

Tendonitis

Preliminary Diagnosis: Tendonitis

I. What imaging technique is first-line for this diagnosis

MR imaging

II. Describe the advantages and disadvantages of this technique for diagnosis of tendonitis.

Advantages

  • Able to detect other causes of pain or weakness in the joint such as tenosynovitis or tears of the tendons.

  • Does not use ionizing radiation.

Disadvantages

  • Expensive

  • Time-consuming imaging modality

  • Requires marked patient cooperation to limit motion artifact.

  • MR imaging with intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR > 30 and < 60.

III. What are the contraindications for the first-line imaging technique?

  • Contraindicated in patients with non-MR compatible metallic hardware and foreign bodies.

IV. What alternative imaging techniques are available?

  • Radiography

  • Ultrasound

  • CT with or without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tendonitis.

Radiography

Advantages

  • Inexpensive and easy to perform

  • Requires minimal patient cooperation.

  • Can detect calcific tendinopathy and heterotopic calcifications in chronic cases.

Disadvantages

  • Low sensitivity, radiographs usually normal.

Ultrasound

Advantages

  • Able to detect disruption of normal tendon architecture and areas of tear.

  • Color Doppler can aid diagnosis without the potential complications of contrast administration.

  • Relatively inexpensive and portable imaging modality

  • Does not use ionizing radiation.

Disadvantages

  • Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology.

  • Limited evaluation in obese patients.

CT with or without contrast

Advantages

  • Can detect calcific tendinopathy and heterotopic calcifications in chronic cases better than radiography.

  • Further detail of bone to assess for fracture and degenerative changes.

  • Relatively quick imaging procedure

  • Requires little patient cooperation and is associated with less motion artifact.

Disadvantages

  • Soft tissue structures and tendons are better evaluated with MRI.

  • Exposes patient to intravenous contrast

VI. What are the contraindications for the alternative imaging techniques?

Radiography

  • No significant contraindications exist.

Ultrasound

  • No significant contraindications exist.

CT with or without contrast

  • Contraindicated in a pregnant patient, especially within the first two trimesters.

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