Tendinopathy: is imaging telling us the entire story?

Sean I Docking, Chin-Chin Ooi, David A Connell

Research output: Contribution to journalArticleOtherpeer-review

54 Citations (Scopus)


Synopsis Tendinopathy is frequently associated with structural disorganisation within the tendon. As such, the clinical use of ultrasound and magnetic resonance imaging for tendinopathy has been the focus of numerous academic studies and clinical discussions. However, similar to other musculoskeletal conditions (osteoarthritis and intervertebral disc degeneration) there is no direct link between structural disorganisation and clinical symptoms, with findings on imaging potentially creating a confusing clinical picture. While imaging shows the presence and extent of structural changes within the tendon, the clinical interpretation of the images requires context in regards to the features of pain and the aggravating loads. This review will critically evaluate studies that have investigated the accuracy and sensitivity of imaging in the detection of clinical tendinopathy and the methodological issues associated with these studies (subject selection, lack of a robust gold standard, reliance on subjective measures). The advent of new imaging modalities allowing for the quantification of tendon structure or mechanical properties has allowed new critical insight into tendon pathology. A strength of these novel modalities is the ability to quantify properties of the tendon. Research utilising ultrasound tissue characterisation and sonoelastography will be discussed. This narrative review will also attempt to synthesis current research whether imaging can predict the onset pain or clinical outcome, the role of monitoring tendon structure during rehabilitation (ie, does tendon structure need to improve to get a positive clinical outcome?), future direction for research and propose the clinical role of imaging in tendinopathy. J Orthop Sports Phys Ther, Epub 21 Sep 2015. doi:10.2519/jospt.2015.5880.
Original languageEnglish
Pages (from-to)842 - 852
Number of pages11
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number11
Publication statusPublished - 2015

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