Skeletal Radiol (2005) 34: 500–512 DOI 10.1007/s00256-005-0956-1 REVIEW ARTICLE Stefano Bianchi Carlo Martinoli Ibrahim Fikry Abdelwahab Received: 23 December 2004 Revised: 11 March 2005 Accepted: 1 June 2005 Published online: 6 July 2005 # ISS 2005 Ultrasound of tendon tears. Part 1: general considerations and upper extremity Abstract The role of ultrasound (US) in assessing musculoskeletal disor- ders is persistently increasing because of its low cost, readiness, noninva- siveness, and possibility of allowing a dynamic examination. Secondary to increased sport practice, tendon tears are more frequently observed in daily medical practice. They deserve early diagnosis to allow proper treatment that can limit functional impairment. The aim of this review article is twofold: to illustrate the US appear- ance of normal tendons and to describe the US findings of the most common tendon tears. Keywords Tendons . Tendon tears . Trauma . Ultrasound . Sonography Introduction Tendon tears are common conditions in daily medical prac- tice. In most cases, preexisting degenerative changes [1], systemic diseases [2–6], or recurrent microtraumas predis- pose a tendon to rupture. The recent increase in frequency of tendon tears is mainly related to ageing and a rise in sporting activities of the general population. Although clinical evaluation remains the mainstay for the early and accurate diagnosis of a tendon tear, posttraumatic local edema and severe pain can limit physical examination, and even complete tears can be missed. But early diag- nosis can reduce patient discomfort and guide the correct choice of surgical versus medical treatment. When a tendon tear is suspected clinically, imaging is required to confirm the clinical suspicion, differentiate a partial from a complete tear, and detect the degree of the proximal tendon end retraction. Different modalities could be used in this effort, each presenting advantages and disadvantages. The final choice of modality depends not only on the particular characteristics but also on local fac- tors, including availability. However, tendon assessment represents one of the best applications of musculoskeletal ultrasound (US) [7–12]. Recent developments in high-frequency broadband trans- ducers have enhanced the diagnostic capacity of US to visualize normal internal tendon arrangement and periten- dinous structures such as retinacula and synovial bursae. Small portable US scanners equipped with 7.5-MHz linear transducers are also available for examining patients im- mediately after injury, even on the sports field. However, they have reduced image quality and diagnostic capabili- ties when compared with larger state-of-the-art equipment, and their accuracy in evaluating smaller structures of the S. Bianchi (*) Fondation des Grangettes Chene-Bougeries; Institut de Radiologie, Clinique des Grangettes Chene-Bougeries, Geneva, Switzerland e-mail: stefano.bianchi@bluewin.ch C. Martinoli Cattedra “R” Radiologia, DICMI, Università di Genova, Genova, Italy I. F. Abdelwahab Department of Radiology, Coney Island Hospital, New York, NY, USA