Mskfreak-Msk Ultrasound Training

The subscapular bursa can be challenging to visualize on ultrasound.

To improve its identification:
🔹 Lower the frequency and increase the depth.
🔹 Position the probe anteriorly.
🔹 Ask the patient to relax the pectoralis major.

This provides a clear view of the anterior glenoid and the subscapularis muscle. The subscapular bursa is located between these structures.

Elbow ultrasound: knowing your neighbours
Start at the anterior elbow over the brachialis muscle and slide the probe laterally — the brachioradialis comes into view, sitting right next to the brachialis.
Now go back to your starting point and move medially 👇
There’s the brachialis again, and beside it an unmistakable oval-shaped muscle: the pronator teres.
Two small movements. Three muscles clearly identified
Systematic scanning beats guessing every single time.
💬 Which landmark do you use to orient yourself at the elbow? Drop it in the comments.

🔍 Bursitis under ultrasound — normal vs. affected side

A classic case: comparing both sides makes the diagnosis obvious. Note the distended bursa with typical internal bundles and mild-to-moderate hypervascularization on Doppler.

💡 Pro tip: don’t push with the probe! Light pressure preserves the fluid and lets you see the bursitis much better.

⚠️ Always consider: rule out septic contamination and rheumatic origin before calling it a simple mechanical bursitis.

Save this one for your next MSK scan 📌

Understanding the relationship between the tibialis posterior tendon and the spring ligament is essential when scanning the medial ankle.

In this video, we demonstrate a simple and highly reproducible technique to:

🔹 Position the probe correctly
🔹 Confirm the position of the spring ligament on ultrasound

A practical approach that can make medial ankle assessment clearer and more reliable.

We hope you find it useful!

Explore this and other scanning techniques in our new Ankle Sprains Ultrasound Course at MSKFreak.

Trochanteric bursitis is not always easy to identify. To visualise it clearly, look for it in areas where the tissues are under less tension, such as along its anterior margin, just superficial to the insertion of the gluteus minimus tendon.

What happens when a bursa becomes pathological?
In chronic bursitis, we can identify thickening of the bursal walls and changes in its content. The fluid is no longer completely anechoic and may show intermediate echogenicity, a characteristic ultrasound finding in chronic cases.
This clip is an extract from the Shoulder Pathology Course, available at MSKFREAK.COM.

In musculoskeletal ultrasound, dynamic maneuvers are essential to distinguish a partial tear from a complete rupture.
In this case, the tibionavicular ligament shows focal thinning in its midportion, raising suspicion of an injury.
However, a static image alone is not always conclusive.
By asking the patient to perform plantarflexion and eversion, a visible gap becomes evident.
This dynamic finding confirms a complete tear of the tibionavicular ligament.
Key takeaway:
Don’t rely solely on the resting image.
Dynamic ultrasound can change the diagnosis.
It can make the difference between suspecting an injury and confirming a full-thickness tear.
In this case, dynamic testing allowed visualization of a clear separation between the ligament ends, confirming a complete tear.
✅ The static image suggests.
✅ The dynamic maneuver confirms.

Comparing with the contralateral side is always helpful.
In this case, the image is completely different: you can see an avulsion at the calcaneal insertion of the ligament, consistent with a complete tear of the calcaneofibular ligament.
A grade 3 injury.
This clip is part of the new Ankle Sprains course, available on 07/06 at mskfreak.com.

Short extract from an upcoming SK ultrasound course.

Patient referred after an ankle sprain.
Scanning the peroneus brevis tendon to its insertion at the base of the 5th metatarsos to rule out fractures.

Clinical ultrasound. Real cases. Coming soon.

MSKFREAK.COM