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Tendons are strong specular reflectors - fibrillar pattern - closely spaced, parallel, bright linear reflections at 90 degrees. Anisotropy (variable echogenicity based on the orientation of the transducer). Muscle is composed of many fascicles (hypoechoic) separated by fibrous tissue - perimysium (echogenic). Peripheral nerves are hypoechoic surrounded by hyperechoic epineurium.

Tendon Rupture

Blunt tendon tip, refractive shadowing, Nonvisualization, Mass, loss of fibrillar architecture, fluid collection

Tendonitis, Tenosynovitis

Fluid distending the tendon sheath and/or thickening of the tendon sheath

Rotator cuff

4 tendons: Subscapularis, Supraspinatus, Infraspinatus, Teres minor --> band of tissue covering the humeral head.

Series of layers from deep to superficial:

Normal cuff: outer convexity contour, lack of compressibility w/ transducer

Rotator cuff tears

The majority of tears originate at the site of insertion of the supraspinatus to the greater tuberosity. From here they may extend posteriorly to the infraspinatus, medially to the more proximal supraspinatus.

Full thickness tears:

Supraspinatus tear: the tear involves only first 1.5 cm of cuff behind the biceps tendon

Infraspinatus tear: if more than 1.5 cm, supraspinatus and infraspinatus

Partial thickness tears: hypoechoic defect, not associated w/ contour changes and do not compress w/ transducer pressure

Calcific tendinitis: painful, echogenic w/ shadow


Baker’s cyst

Between medial head of gastrocnemius and the semimembranosus tendon. Simple, internal septations, irregular thick walls, nodular synovial proliferation, loose bodies. Beak like appearance of the neck protruding between medial gastroc and the semimembranosus tendon. If ruptures, fluid tracking into the calf


cystic, complex, solid, localizing, relationship, vascularity

Ganglion cysts

70% originate from scapholunate joint over the dorsal surface of the wrist. 20% arise on the volar side around the flexor carpi radialis tendon or the radial artery. 10% arise along the flexor tendon sheaths of the fingers and from the interphalangeal joints. Anechoic w/ well defined walls, through transmission

Giant cell tumor

2nd most common mass in the hand, bng lesion histologically identical to pigmented villonodular synovitis, volar surfaces of the fingers. Solid, homogeneous, hypoechoic masses w/ blood flow, (can be quite vascular) adjacent to tendons. Arise from sheath, not tendon, therefore they do not move w/ finger movement


In the middle of nerve


In the periphery of nerve. Solid, hypoechoic, vascular

Morton’s neuroma

Mass of the plantar digital nerves, between metatarsal heads


Edema, fluid dissects in the fibrinous retinaculum of the subq fat - marbled appearance


Normal arterial waveform of the extremity has high-resistance profile, triphasic. Exercise will transform waveform to low-resistance profile.

Sensitivity of US for DTV is 95% and specificity is 98%: Noncompressibility, Augmentation of venous flow by calf compression or plantar flexion. Alteration of the venous pulsatile (respiratory phasicity) waveform --> becomes blunted due to more central obstruction --> loss of respiratory phasicity (subclavian - thrombosis, stenosis, extrinsic compression)


Extravascular blood flow near or adjacent to the artery (hematoma w/ persistent arterial communication via patent neck), yin-yang pattern, “to and fro” waveform pattern in the neck. Treatment: US guided injection of thrombin (contraindicated if wide neck or pseudoaneurysm is a part of AVF)


Below the femoral bifurcation, prominent perivascular tissue vibration, change from nl high-resistance pattern to low resistance flow in supplying artery and arterialization of venous waveform