What I mean by granulation is the healing phase of a tear.
You see it commonly in the SST and subscap,
It begins with an acute tear that often has some delimitation component to the tear.
The next thing that happens is the tendon tries to repair the defect by laying down granulation (scar) tissue. This granulation tissue appears echogenic relative tot he adjacent healthy tendon tissue. It usually looks like a longitudinal echogenic line in the tendon and also if you follow the line to the entheisis you will see a small sub-periosteal cyst (irregularity) pit in the enthesis where the delaminating began.
This granulation Aussie may or may not include some dystrophic calcification so when you x-ray it you usually don’t see calcification but on occasions there may be a small amount of calcium as part of the granulation process.
It is most important to understand that the pathophysiology here is NOTHING like hydroxyapatite deposition and must not be confused with calcific tendinosis. If this mistake is made any attempt to perform a barbotage / lavage procedure will fail.
Steve