Musculoskeletal Sonoelastography: A Focused Review of its Diagnostic Applications for Evaluating Tendons and Fascia

Although its clinical utility remains under investigation, sonoelastography has demonstrated potential for use as an adjunct diagnostic tool in musculoskeletal medicine. Sonoelastography is a diagnostic ultrasound technique that provides a noninvasive means of estimating soft tissue elasticity and stiffness. It is based on the principle that the compression of soft tissue produces strain that is greater in tissues that are softer and more elastic than in harder, more rigid tissues. Pathological and healthy tissues can present with similar echogenicity and morphology on conventional ultrasound. However, alterations in tissue elasticity often occur with degeneration or other pathological changes that involve the soft tissues. When evaluating tendinopathy, in addition to observing changes in echogenicity and morphology, physicians should also consider measuring tendon stiffness and elasticity. This review article addresses the theoretical background, clinical utility, and technical limitations of sonoelastography for the diagnosis of common tendinopathies and plantar fasciitis.