#29477
Stephen Bird
Keymaster

Hi Dave,

I will find some cases for you, but I want you to go about this in a different way.

Personally I don’t like long axis imaging of the hamstring origin with the exception of measuring the length of a conjoint tendon stump, retraction distance or gap.

For assessment of tendinosis I find it very unreliable,

You can make it look as thick or thin as you want to with a tiny wiggle of the transducer and it is difficult to get nce fibrillar texture.

I prefer a short axis approach with the transducer placed a little lateral to the ischial tuberosity and angled back toward it. That gives you a better angle by flattening out the profile of the ischial tuberosity. Using this view you have 2 advantages.

Firstly you can do REAL comparison my getting the bony architecture symmetrical on each side giving you a genuine comparison.

Secondly you get a great look at the enthesis for enthesopathy at the same time as the tendon for tendinosis.

It also allows you to do an internal / external rotation manoeuvre looking for ischiofemoral impingement as well as sciatic nerve mobility.

Hence I have virtually given up long axis imaging in the hamstring complex except for measuring haematomas and retraction distances.

Another advantage is that I find I can control anisotropy better and make genuine comparisons of echogenicity of the tendon origins.
In the long axis the architecture of the collagen makes it really hard to control anisotropy,

Steve

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