Case Study

How to tendinopathy 3: using the ultrasound report

July 7, 2020

A guide to using the findings in an ultrasound report indicating tendinopathy.


In the previous two posts we have talked about the continuum model of tendinopathy according to Jill Cook’s research group. The idea that tendinopathy is a process of injury, the aetiology of which appears to lie in periods of inappropriate or abusive loading of a tendon, may explain pain experienced by patients across the different stages of the continuum. This abusive load leading to areas of reactive tendon cells may also help resolve a persistent problem with historical models of tendon pathology; the changing source of nociception.


Remember the days when tendonitis existed, and inflammation of the tendon was what caused pain to patients in the acute tendon injury?


Remember when tendinosis was still a term used to describe more chronic tendon pathology, and then somehow the source of nociception changed from inflammation to innervated vascular structures?


We will revisit those questions next time. In the meantime we’ve developed a simple guide (Figure 1 below) to using the terminology you will see in our reports to position a patient’s tendon injury within the continuum, as well as some broad ideas about how you might begin to reason your way through managing tendon dysfunction. If you want a bigger version, click the link to the pdf of the tendon report interpretation guide.

Of course these ideas are not invented by us. Have a look at the references we’ve previous cited for a more in-depth look, listed again at the bottom of the page.


Figure 1: shows how tendinopathy is described in the wording of the ultrasound report (left of figure) and corresponds with ultrasound images captured (centre of figure). Broad management ideas within stages of the tendinopathy continuum are outlined (right of figure) as well as recommended rescan time points.


Coming in the next post:

We’ll talk about tendinopathy in a case study, and present theories of what may be causing pain during different stages of tendon pathology.


References to read:

Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43:409–16.

Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med [Internet]. 2016;bjsports-2015-095422-. Available from:

Cook JL. Ten treatments to avoid in patients with lower limb tendon pain. Vol. 52, British journal of sports medicine. England; 2018. p. 882.

Cook JL, Docking SI. “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissuehere….” Defining ‘tissue capacity’: a core concept for clinicians. Vol. 49, British journal of sports medicine. England; 2015. p. 1484–5.

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