Complete Tendons Tear

Fig. 3.37a,b. Complete tendon tear, a Long-axis 12-5 MHz US image over the quadriceps tendon with b fat-suppressed T2-weight-ed MR imaging correlation shows a transverse hypoechoic gap in the tendon substance fiUed with fluid (asterisks) between the proximal and distal ends (arrows), consistent with a complete rupture. Note that the tendon tear forms a communication between the joint and the prepatellar bursa. P, patella... 

Surgical treatment in complete tendon tears includes repair and reattachment of the retracted tendon to the radial tuberosity or, alternatively, to the brachialis muscle or the ulnar tuberosity. The first technique gives better results in restoring supination but has a significantly higher risk of radial nerve injury. After surgery, the tendon appears thickened and hypoechoic with internal linear hyperechoic images related to sutures (Fig. 8.31). 

US assessment of proximal hamstrings lesion can be difficult in cases of hypertrophied thighs because the insertion point is located deeply and the soft-tissues of the buttock may have a substantial thickness. In addition, any pressure exerted with the transducer in an attempt to reduce the distance between the affected tendons and the skin can be painful in acute phases. In complete tendon tears, US can demonstrate the discontinuity of the affected tendon, which appears retracted downward and surrounded by local hematoma, whereas the adjacent nonaffected tendon can he seen inserting normally into the hyperechoic cortex (Fig. 12.54). Partial tears can be more difficult to assess and differentiate from focal tendinopathy. In general, they extend more distally downward to reach the myo-... 

Fig. 6.84a,b. Complete (full-thickness, full-width) tear of the supraspinatus tendon, a Transverse 12-5 MHz US image over the cranial aspect of fhe humeral head (HH) wifh b T2-weighted MR imaging correlation demonstrates a wide defect (arrows) of cuff tissue from immediately posterior to the intra-articular portion of the biceps tendon (bt) to the superior boundary of the infraspinatus tendon (IS), reflecting a complete retracted tear of the supraspinatus tendon... 

While tears of the infraspinatus tendon are almost invariably associated with rupture of the supraspinatus, subscapularis ruptures can also be encountered as an isolated problem. Subscapularis tendon tears are mainly related to acute traumatic lesions produced with the arm abducted and in external rotation. Similar to other rotator cuff tendons, complete tears of the subscapularis are revealed by the absence of tendon fibers and the concavity of the deltoid over the naked anterior surface of the humeral head. Incomplete tears of the subscapularis tendon often involve the cranial and preserve the caudal portion of the tendon (Fig. 6.90). This pattern should not be mistaken for complete tears. For this purpose, the morphology of the lesser tuberosity as seen on sagittal planes may help to establish the caudal limit of the tendon and avoid any confusion... 

Disruption of the cranial third of the subscapularis tendon, either in isolation or associated with supraspinatus tendon tear, is often associated with biceps instability (Bennett 2001). When the cranial third of the subscapularis is torn, the biceps tendon tends to sublux superficial to it on cranial transverse scans and to rest in a normal position on caudal transverse scans (Fig. 6.117). When the subscapularis tear becomes complete, the biceps slips medially within the glenohumeral joint (Ptasznik and Hennesy 1995 Farin et al. 1995 Farin 1996 Prato et al. 1996). The US diagnosis of biceps tendon dis-... 

Fig. 8.26a,b. Distal biceps tendon tear physical findings. Photographs of two different patients who underwent a subacute and b chronic complete rupture of the distal hiceps tendon. In a, the patient injured his left tendon while attempting to lift a heavy object. He presented with hemorrhagic skin over the medial elhow and proximal forearm and with a proximal lump (arrowheads) in the anterior aspect of the arm related to the retracted muscle. In b, the patient was a competitive body-builder who refused surgical repair of the ruptured tendon. Note the defect (arrowhead) in the anterior left arm due to the retracted muscle in comparison with the right side... 

Distal triceps tendon tear is an uncommon condition that mostly occurs at or close to the olecranon process of the ulna, often associated with a fleck of bone attached to the retracted tendon as a result of avulsion fracture (Fig. 8.47). The mechanism involves either forced flexion of the elbow against a contracting triceps, as occurs during a fall on an outstretched arm, or relates to a direct blow onto the olecranon process. Local steroid injection into the olecranon bursa, anabolic steroid abuse and pre-existing tendinosis may also have a role in the tendon rupture. As a rule, complete tears occur more... 

Fig. 12.29a-c. Rectus femoris tendon tear, a Long- and b short-axis 12-5 MHz US images obtained over the insertion of the proximal tendon of the rectus femoris on the anterior inferior iliac spine (AIIS) reveals a complete tear of the direct rectus femoris tendon (arrowhead) which appears retracted downward. A hypoechoic collection reflecting the hematoma (asterisk) is seen between the retracted tendon and the iliac spine. Superficial to the ruptured tendon, the iliacus and the sartorius (Sa) muscles can be appreciated, c Corresponding long-axis 12-5 MHz US image on the contralateral side demonstrates the intact rectus femoris tendon (arrows) which inserts into the anterior inferior iliac spine... 

Fig. 12.47a,b. Gluteus medius anterior tendon tear, a Coronal and b transverse 2-4 MHz US images reveal a complete tear of the gluteus medius tendon (GMe) which appears retracted proximally (arrowheads) from the insertion site (curved arrow). An anechoic effusion related to the hematoma (asterisks) is seen between it and the greater trochanter (GT), also expanding within the trochanteric bursa... 

Full-thickness tears of the quadriceps tendon present with complete discontinuity of all tendon layers (Fig. 14.45b). Thelocationofthesetearsisnearly the same as that of partial tears. Occasionally, bony avulsion from the upper pole of the patella occurs (La et al. 2003). In complete intrasubstance tears, US detects two swollen hypoechoic tendon stumps separated by hypoechoic hematoma (Fig. 14.47). The proximal tendon end can be retracted for a variable distance depending on the strength of the musde in general, the distal stump measures 1-2 cm in length (Fig. 14.47). In full-thickness tears of the quadriceps tendon, an intra-articular effusion is almost always seen reflecting a break in the suprapatellar recess. The medial and lateral retinacula should also be... 

Fig. 14.60a,b. Complete patellar tendon tear, a Lateral radiograph of the affected knee demonstrates cranial displacement (arrow) of the patella as a result of traction from an intact quadriceps tendon, b Longitudinal 12-5 MHz US image of the infrapatellar region confirms the complete rupture of the patellar tendon (arrows). The tendon appears wavy and retracted from its patellar insertion. A small fleck of bone (arrowhead) is attached at its proximal edge, as a result of an avulsion mechanism. T, tibia... 

Fig. 16.76. Complete rupture of the Achilles tendon. Long-axis extended field-of-view 12-5 MHz US image demonstrates with difficulty the separation of the torn tendon ends because of an ill-defined hypoechoic hematoma (asterisks). Note the anterior orientation of the distal tendon end (arrow) this is a common finding in Achilles tendon tears. C, calcaneus...

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