On ultrasound tendons usually display a hyperechoic fibrillar pattern.
In transverse axis the tendon looks like “pepper and salt” – mass of hyperechoic granules alternating with hypoechoic granules of the same size, evenly distributed. In longitudinal axes a healthy tendon looks like “spaghetti”.
When the tendon is not perpendicular to the insonation angle anisotropy can cause artifactual appearance resembling tendinosis or tendon tears.