Stephen Bird

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,


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