Thanks a lot for the answers. unanimity that synovial effusion in the bicipital sheath is a nonspecific finding.
The responses received are below:
Ciro
NON specific at all
just fluid in the articular space like anywhere in the joint
in our ultrasound, or MR templates, we only say small amount of fluid, mild distention, moderate distention or marked distention.
Only if there is color Doppler flow and pain, call it tenosynovitis
If there are septations and loculations, I call it stenosing tenosynovitis with a restriction of tendon movement on elbow flexion and extension
I agree..very nonspecific. If there is fluid in the joint and the biceps sheath I don’t tend to say anything about it. If there is no fluid in the joint but a lot of fluid in the bicipital sheath I will then call it tenosynovitis. this goes for both US and MRI for me
If there is flow on Doppler I would read tenosynovitis.
It can be normal communication with the joint.
It can be seen with biceps tendinosis, either intra or extra articular segment.
It can be seen secondary to adhesive capsulitis.
So very non specific.
I agree this is nonspecific and often a reflection only of glenohumeral joint effusion. The vincula often adds to the confusion. I only call tenosynovitis if the patient is symptomatic to sonopalpation or has significant synovitis here.
My trend is to call this tenosynovitis if there is no or only minimal shoulder iffusion /if the fluid in the shoulder and in tendon sheath are significantly disproportionate. But as you seid it os a common finding in patients who has no tenderness on sonopalpation.
doing a bit more than 100 US a week, I see fluid around the biceps many times a day (usually on both sides without any connection with pain) and I even do not mention it in my reports. I mention it when there is fluid all around the tendon but this is purely speculative and probably just a way to quantify it. However, fluid does not mean synovitis and we probably need to see increased vascularization with Power doppler.
Agree with the comments.
Also, recent full thickness rotator cuff tears also result in increased fluid in the biceps tendon sheath.
Dear OCADERS,
Colleagues, who perform ultrasound examinations of the shoulder, describe tenosynovitis whenever there is synovial effusion surrounding the bicipital sheath.
For me this finding is nonspecific.
What do you think?Ciro
