**6.2 Ultrasound examination technique**

Examination can be divided in the following approaches [24, 25]:


**27**

**Figure 6.**

*along the greater trochanter.*

*Imaging of Tendons*

**6.3 Gluteal tendons**

adipose tissue [26].

*DOI: http://dx.doi.org/10.5772/intechopen.84521*

medially located semimembranosus muscular belly.

moved caudally, distinction between individual hamstring tendons is achieved with the semimembranosus tendon located deep and medially in relation to the conjoined tendon complex of the biceps femoris and semimembranosus. Sonographic appearance of this conjoined tendon complex is a hyperechoic line that separates the laterally located biceps femoris muscular belly from the

The gluteus medius and gluteus minimus tendons are part of the lateral compartment of the hip. The gluteus medius tendon inserts at the lateral and superoposterior facets of the greater trochanter of the femur, while the gluteus minimus tendon inserts at the anterior aspect of the greater trochanter. Ultrasound shows the gluteus medius tendon as a hyperechoic structure arising from a fan shaped hypoechoic structure that represents the gluteus medius muscle. The gluteus medius and minimus muscles are separated by an echogenic layer of fascia and

The gluteus medius and minimus are the most commonly affected tendons of the hip abductor group that cause greater trochanteric pain syndrome [28]. Gluteus tendon abnormalities may be due to acute injury or chronic wear and tear of the hip joint. Therefore, it typically affects women in the middle and elderly age groups. MRI is the gold standard imaging modality for the identification of gluteus tendon tears (**Figure 6**). Axial and coronal T2W fat saturated images of the hip and coronal T1WI of the pelvis are recommended when abductor tendon pathology is suspected [29]. MRI diagnostic criteria for tendon tears include discontinuity of the tendon, elongation of the gluteus medius 2 cm or greater and T2 hyperintensities superior to the level of the greater trochanter of the femur [27]. Additional MR findings, although nonspecific, may include atrophy of the adipose tissue, changes

of the adjacent bone structures and fluid collection within the bursa.

*T2 fat saturated axial image shows a full thickness tear of the gluteus medius tendon as a fluid-filled defect* 

moved caudally, distinction between individual hamstring tendons is achieved with the semimembranosus tendon located deep and medially in relation to the conjoined tendon complex of the biceps femoris and semimembranosus. Sonographic appearance of this conjoined tendon complex is a hyperechoic line that separates the laterally located biceps femoris muscular belly from the medially located semimembranosus muscular belly.
