Use this link to view the PDF file: ASSESSMENT OF TENDON AND TENDON SHEATH PATHOLOGY FOLLOWING THERAPEUTIC INJECTION: THE TENOSONOGRAPHIC EFFECT
Purpose: To determine whether the distension of a tendon sheath with fluid improves the conspicuity of tendon morphology, tendon sheath thickening and synovitis.
Materials and Methods: Three musculoskeletal radiologists experienced in performing musculoskeletal ultrasound retrospectively reviewed a total of 39 cine clips that were obtained from 17 patients (age range = 21-67, 13 female and 4 male) both before and after therapeutic ultrasound-guided tendon sheath injection (6 peroneal tendons, 10 flexor hallucis longus tendons, 1 flexor carpi ulnaris tendon). In some cases, multiple cine clips were obtained for a single patient. The cine clips were anonymized and presented to the radiologists in random order, after which the radiologists were asked to complete a response form addressing whether the tendon and tendon sheath were well delineated, as well as the presence of tendon sheath thickening, degree of tendon sheath distension, tendinosis, synovitis, and a tendon tear. For each question, the radiologists were asked to provide their confidence level on a 1 (extremely confident)-5 (not at all confident) scale. For all questions in which the radiologists reported one of the previously mentioned findings, the radiologists were asked to assess the percentage of the cine clip during which the finding was clearly visualized. Statistical analysis included logistic regression and mixed model analysis of variance.
Results: For each question, at least one radiologist’s answer changed after the injection of fluid into the tendon sheath in a statistically significant manner (p value 0.001-0.049). Each radiologist’s confidence level increased when evaluating post-injection cine clips as compared to the pre-injection cine clips. There was a statistically significant increase in the confidence level of all three radiologists (p value <0.001-0.044) when asked to evaluate the conspicuity of the tendon margins as well as the presence of synovitis. There was increased concordance amongst the radiologists when evaluating the tendons and tendon sheaths after the injection of fluid, which achieved statistical significance for five out of seven questions (p value <0.001-0.049).
Conclusion: The conspicuity of tendon and tendon sheath morphology was improved after the distension of the tendon sheath with fluid. In addition, radiologist confidence level and concordance was improved on post-injection imaging when compared to pre-injection evaluation.