I see a lot of tendinopathy in my practice. I've discussed my thoughts about tendinopathy management in previous blogs. Despite an explosion of research in the last 10 years, I'm still amazed at how little we know about tendinopathy.
Take the simple case of imaging in tendinopathy. Traditionally, we have used ultrasound or MRI to image tendinopathy. I think a majority of practitioners who work with tendons use ultrasound. Its many advantages include lower cost, greater availability (I use ultrasound in my rooms), better tendon resolution and the ability to measure blood flow. Normal tendons show perfectly aligned collagen bundles and very little in the way of blood flow (see fig 1). On the other hand, tendinopathy demonstrates thickening and darkening (hypochogenicity) arising from accumulation of water in the tendon. In addition, there is increased blood flow that is seen on ultrasound as color in the tendon. Increased flow in a tendon represents more severe tendon disease or tendinopathy (see fig 2).
So far so good for ultrasound. However, we run into a few problems if we want to track changes over time, say after a rehabilitation program or an injection. This is where it gets a little tricky because it's very difficult to grade severity of tendinopathy on ultrasound as changes are subjective and are altered by factors such as machine settings or recent exercise.
Fortuitously, there is a novel imaging modality that uses the physics of ultrasound but is able to objectively grade tendon changes using different colours. In my next week's blog, I will discuss this novel imaging modality called Ultrasound Tissue Characterisation or UTC and how it could potentially change the way we manage tendons.