The patient has injured his right Achilles tendon a few weeks ago which was treated conservatively. The patient reports no pain (VAS: 0) but a considerable loss of strength. The patient sports a lot. The left Achilles tendon is asymptomatic.
Analyzing the images according to the SonoSkills pathology checklist the following items are being scored: 1. Shape: the tendon has increased in cross sectional area and thickness (L: 6,1 mm versus R: 15,3 mm); the paratenon shows an increase of thickness as well (L: 0,88 mm versus R: 1,6 mm). 2. Echogenicity: a large anechoic zone can be seen mid tendon which appears to be an effusion. Parts of the tendon and the paratenon both have a hypoechoic appearance. A part of the tendon is hyperechoic due to the acoustic enhancement artifact. 3. Continuity: a large zone in the Achilles tendon shows no continuity of fibers (approx. 24,5 x 8,0 x 12,3 mm). The tendon is compressible. 4. Doppler: a light to moderate positive power Doppler signal can be seen. 5. Function: no clips where made of ultrasound visualized Achilles tendon loading.
Severe mid tendon partial tear, tendinopathy and moderate neovascularization of the right Achilles tendon.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
More Cases from Marc Schmitz
