Achilles tendinopathy: MRI

Case details : Peritendinous fluid around the tendoachiles.  Thickeness of the tendoachilles appears normal. Suggestive of peritenditis.

Teaching Points :

•  The Achilles tendon does not possess a synovial sheath. It is surrounded by a loose areolar tissue, called the paratenon.
• Histologically, tendinopathy is characterized by an absence of inflammatory cells and a poor healing response, with non-inflammatory intratendinous collagen degeneration, fibre disorientation and thinning, hypercellularity, scattered vascular ingrowth, and increased interfibrillar glycosaminoglycans.
• Paratendinopathy may occur alone or in combination with degeneration of the tendon body. Histologically, mucoid degeneration, fibrosis and vascular proliferation with a slight inflammatory infiltrate have been reported. Clinically, oedema and hyperaemia of the paratenon are seen