Learn MSK Sono

Don’t Miss the Fluid Hiding in the Recesses 🦵💧

Most missed knee effusions aren’t absent… they’re just not where you looked.

Fluid moves freely throughout the joint — so if you’re only checking the suprapatellar recess, you’re leaving blind spots.

🎥 Watch the full reel here:
👉 [https://www.instagram.com/reel/DXHFv5ngHEI/?igsh=OHpuOHJyOWxna2M=]

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🔍 What we’re covering in this video:
• Medial & lateral parapatellar recesses
• Short + long axis views
• Where fluid loves to hide

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📌 Key Takeaways:
• Fluid is mobile — position matters
• Don’t stop at the suprapatellar recess
• Always check medial + lateral recesses
• Use short AND long axis
• Mild flexion helps redistribute fluid

🎯 Complete scan = fewer missed effusions

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🧠 Quick Scan Protocol:
• Suprapatellar recess — short & long axis
• Lateral parapatellar recess — short & long axis
• Medial parapatellar recess — short & long axis

👉 Assess with the knee in mild flexion

👉 Add Power Doppler:
• Evaluate synovium for hyperemia
• Increased Doppler signal → suggests active synovitis
• Helps differentiate simple effusion vs inflammatory process

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Don’t Miss the Fluid Hiding in the Recesses 🦵💧 🔍 Most missed knee effusions aren’t absent… they’re just not where you looked. Fluid doesn’t stay in one place. It moves freely throughout the joint — meaning if you’re only checking the suprapatellar recess, you’re leaving blind spots. In this reel, we’re including the medial & lateral parapatellar recesses in both short and long axis — common collection points that are easy to overlook. ⸻ 📌 Key Takeaways: • Fluid is mobile — position matters • Don’t stop at the suprapatellar recess • Always check medial + lateral recesses • Use short and long axis for full assessment • Mild flexion helps redistribute fluid 🎯 Complete scan = fewer missed effusions ⸻ 🧠 Scan Protocol: • Suprapatellar recess — short & long axis • Lateral parapatellar recess — short & long axis • Medial parapatellar recess — short & long axis 👉 Assess with the knee in mild flexion to help redistribute fluid 👉 Add Power Doppler: • Evaluate synovium for hyperemia • Increased Doppler signal → suggestive of active synovitis • Helps differentiate simple effusion vs inflammatory process ⸻ #TuesdayTipsWithJamie #KneeUltrasound #MSKUltrasound #JointEffusion #UltrasoundEducation

🚨 Tuesday Tip with Jamie

Can you recognize the bare area on shoulder ultrasound?

This is a normal region without cartilage — and recognizing it is key to accurate interpretation.

🎥 Watch this quick video to train your eye and feel more confident when scanning:

Follow along for more weekly tips!

🚨 Shoulder Ultrasound Tip: Know the Bare Area The “defect” at the rotator cuff footprint is the bare area of the greater tuberosity — a normal region without cartilage coverage. On ultrasound, it can look: • Slightly hypoechoic • Irregular • Like a small cortical defect 💡 If a tear is present in this region: It should NOT be described as an articular-surface tear 💡 Memorizing the normal footprint is key to avoiding false positives Recognizing this = more confident scans and more accurate diagnoses ⸻ #TuesdayTipsWithJamie #MSKUltrasound #ShoulderUltrasound #RotatorCuff #ultrasound

Reposting an interesting MSK ultrasound case from my colleague (and co-director of our upcoming course) 👇

This is exactly the kind of real-world, case-based learning we focus on—understanding pathology, thinking through the diagnosis, and applying it directly in clinical practice.

Our upcoming course is officially sold out 🙌
Thank you to everyone who signed up—really looking forward to it.

If you’re interested in attending a future course, send me a message with your email . I’ll make sure you’re the first to hear when new courses open.

Small group. Big skills. 💪🖥️

See it. Follow it. Question it. 👀

The superficial peroneal nerve is small and easy to overlook—but when it becomes enlarged at the point where it exits the crural fascia, it’s often a sign of entrapment.

📍 Where to find it:
• Between the peroneus longus and extensor digitorum longus
• Distal lateral leg as it becomes more superficial
• Pierces the crural fascia (anterior to the fibula)
• Becomes subcutaneous just above the ankle

⚠️ Important:
Entrapment often occurs right where the nerve pierces the fascia and transitions to a superficial location.

In this case:
• Focal enlargement at the fascial exit
• Clear caliber change on long axis
• Increased cross-sectional area

⚠️ Symptoms can be subtle:
• Burning or tingling along the lateral lower leg
• Dorsal foot paresthesia
• Worse with activity
• Often no motor deficit

➡️ Easy to mistake for tendon or lateral ankle pathology

🎥 Watch the video to see how this looks on ultrasound.

Pro tip:
Use a cine loop and follow the nerve dynamically—this is where you’ll catch subtle abnormalities.

👉 Follow the nerve
👉 Compare sides

If it catches your eye… there’s usually a reason.

See it. Follow it. Question it. The superficial peroneal nerve is small… easy to overlook… —but when it’s enlarged at the fascial exit, it’s often entrapment. 📍 Find it here: • Between peroneus longus + extensor digitorum longus • Distal lateral leg → tracking superficial • Pierces crural fascia (anterior to fibula) • Subcutaneous just above the ankle ⚠️ Key point: Entrapment happens where the nerve approaches → pierces fascia → becomes superficial In this case: • Focal enlargement at fascial exit • Caliber change on long axis • Increased cross-sectional area ⚠️ Symptoms aren’t always obvious: • Lateral leg burning/tingling • Dorsal foot paresthesia • Worse with activity • Often no motor deficit ➡️ Easy to mistake for tendon or lateral ankle pathology 🎥 Pro tip: Use a cine loop Follow it dynamically to the fascial exit Look for subtle caliber change 👉 Follow the nerve 👉 Compare sides If it catches your eye… there’s usually a reason. #TuesdayTipsWithJamie #MSKUltrasound #MusculoskeletalUltrasound #UltrasoundEducation #peripheralnerve