“HSS Ultrasound of the Month Case 122

Clinical History 58 year old male with Achilles pain related to running.

Diagnostic ultrasound of the Achilles tendon was requested.

Ultrasound of the Month – Case 122

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Ultrasound of the Month – Case 122

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Diagnosis: Achilles Paratenonitis The Achilles tendon lacks a true tendon sheath but has a single-cell membrane-like tissue immediately posterior to it known as the paratenon.

Chronic overuse of the Achilles can result in paratenonitis, which is irritation of the paratenon due to repetitive microinjury.

On ultrasound, the paratenon of the Achilles tendon is normally thin and barely perceptible.

In paratenonitis, the paratenon is thickened and hypoechoic (darker) and there may be associated hyperemia on power Doppler. This has a different appearance than tendinosis, which would manifest as abnormal thickening and hypoechoic change of the Achilles tendon itself.

The management of Achilles paratenonitis is the same as that for tendinosis, including rest, ice, NSAIDS, and training modification.

Ultrasound of the Month – Case 122

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