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.