Tendon structure, disease, and imaging

Tendon imaging plays a critical role in evaluating tendon diseases and injuries including mechanical, degenerative, and overuse disease, inflammatory enthesitis, as well as partial and full thickness tears. Ultrasound and magnetic resonance imaging (MRI), each with unique benefits and limitations, are commonly utilized to assist in diagnosing these diseases and conditions. This review delineates important structural properties of tendon and biochemical changes occurring in tendon pathology. This review also examines commonly injured tendons including tendons of the elbow, tendons of the rotator cuff of the shoulder, hip abductor tendons, patellar tendons, and the Achilles tendon to help clinicians better recognize tendon disease. Finally, this paper introduces several emerging imaging techniques including T2 mapping, ultra-short echo time MRI, and sonoelastography as ways in which tendon imaging and evaluation may be improved.