Clinical Information

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.

Brief Description

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.

Ultrasound Images & Clips

Conclusion

Severe mid tendon partial tear, tendinopathy and moderate neovascularization of the right Achilles tendon.