Tenography

BACKGROUND:

There are three types of tenosynovitis, clinically divided into peritendinitis, chronic tenosynovitis, and stenosing tenosynovitis. This relates to inflammation around a tendon.

These conditions are a common cause of chronic foot and ankle pain.

The diagnosis of these conditions is usually performed through the use of ultrasound and MRI.

DIAGNOSIS:

This technique is utilised if the problem is thought to relate to stenosing tenosynovitis.

This is mostly a clinical diagnosis with the tendon and its respective sheath appearing normal on all imaging modalities.

A patient may be tender with pressure over the involved tendon with pain with activity.

If there is a high index of suspicion then tenography / tendon sheath hydrodissection may be performed.

This is usually undertaken after other forms of therapy, including, immobilization, bracing, physical therapy, foot orthoses and sometimes steroid and anaesthetic injection into the tendon sheath has failed.

PROCEDURE:

In this procedure, under ultrasound guidance, anaesthetic, steroid and normal saline (salt water) are injected into the tendon sheath which relieve the adhesions.

At time of procedure, the appearance ranges from mild synovitis, with minimal irregularity of the sheath to severe synovitis with marked irregularity, outpouchings and nodularity. One can often feel the adhesions breaking down as one injects the fluid.

The procedure itself is undertaking using a small gauge needle, and is almost always very well-tolerated.

Depending on the region treated, one can usually drive oneself to and from the appointment.

RISKS:

There are no significant risks after this injection. Standard risks include such as infection and bleeding. Risk of tendon rupture is extremely rare.

POST PROCEDURE:

Post procedure, physiotherapy is usually started after 3 to 5 days.

Reference article:

Diagnostic and Therapeutic Ankle Tenography Outcomes and Complications, Noah W. Jaffee, Louis A. Gilula, etal. Musculoskeletal imaging, February 2001, volume 176, number two  

 

Tenography

XR image of the outer aspect of the ankle after injection of contrast into tendon sheaths of the peroneal tendons. Note the upper portion white contrast injected is smooth, outlining the black tendons, but lower down the white contrast is very irregular, in keeping with stenosing tenosynovitis.

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Credentials

Dr Berman is a dual specialist – Musculoskeletal Radiologist and Vein Specialist (Phlebologist)
Please click on Specialist Vein Care to see dedicated website.