Marek performing a private ultrasound scan on a patients wrist

Ultrasound Scan

During your ultrasound scan appointment, you will receive:

  • Physiotherapy consultation, including clinical examination of your injury
  • Diagnostic ultrasound scan (POCUS). 
  • Scan report 
  • Exercise program (we use exercise software called  P-REHAB Guys)
  • Scan with  Marek Czeladzki – Chartered Physiotherapist and Sonographer. 


Based on both clinical examination and the ultrasound scan findings, you will receive either the diagnosis of your injury or further investigations may be recommended (i.e. MRI).

Marek performing an ultrasound scan on a patients ankle

Ultrasound scans in musculoskeletal pathology

Ultrasound allows me to enhance clinical examination, confirm the diagnosis, and rule out other possible causes of pain. It also helps me manage patient care better and reassure patients that their condition is treatable. An ultrasound scan is fast, safe, and relatively inexpensive. It has changed the way I look at human anatomy and physiotherapy.  


I will be regularly updating and adding more content to the following article. Hope you find it helpful. Marek


Ultrasound Scan

Ultrasound is a quick, cost-effective and accurate scan of musculoskeletal structures. In some respects, due to its high resolution, it may be better than MRI ( i.e when scanning tendons). 

MSK (musculoskeletal) ultrasound uses sound waves to produce pictures of muscles, cartilage, tendons, ligaments, nerves, and joints throughout the body. There are no side effects and no radiation that patients are exposed to.

Medical ultrasound (US) can be a powerful tool in the hands of clinician. It can help answer one key question; what type of injury are we dealing with?  US is used in various fields of medicine, and in physiotherapy we use it often to assess musculoskeletal injuries.

It is particularly useful when we suspect an injury outside the joint (extra-articular injuries). For that reason, it may be used to assess such injuries as:

  • Tennis elbow
  • Shoulder injuries – impingement syndrome, rotator cuff tears, bursitis
  • Knee injuries – ligamentous injuries, bursitis, tendinopathy, pes anserine, ITB syndrome and many other problems
  • Plantar fasciitis
  • A wide array of sports injuries

Ultrasound is not good at assessing spinal injuries or telling us what is happening within the joint (MRI would be a much better option).

Ultrasound is however much cheaper, and more accessible to patients than MRI. It simply takes minutes to produce images that may help with selecting the best treatment pathway.

Plantar Fascia

The plantar fascia resembles a tendon and is the most common cause of pain in the sole of the foot. A sudden change in training regime ( for example, in runners), doing a lot of walking at work, using uncomfortable shoes, and flat feet are all factors that may cause plantar fasciitis.

There are three cords comprising the plantar fascia, with the central cord most commonly affected by a pathological process. The lateral cord may sometimes be a cause of pain in the lateral foot as it inserts into the base of the fifth metatarsal.

On ultrasound, we see thickening of the fascia, especially of its central cord.  However, sometimes ( ok, it is very rare), you may find calcium deposits in the plantar fascia, which may lead to further investigations, especially if clinically this is justified.

ultrasound scan screen showcasing calcium deposits in the plantar fascia

calcium deposits in the plantar fascia

Shoulder Joint Scan 

Learn more about shoulder injuries

       Your shoulder ultrasound scan will include an assessment of:

  • the long head of the biceps tendon and its grove in the anterior (front part) shoulder
  • condition and integrity of the entire rotator cuff ( read about the rotator cuff and its function here)
  • posterior gleno-humeral joint 
  • ACJ joint – there is a strong link between the ACJ and the shoulder joint pathology, especially rotator cuff pathology. What happens is that due to the rotator cuff pathology, the shoulder joint becomes less stable, and the head of the humerus moves upwards, causing disruption to the ACJ joint capsule. The fluid from the shoulder joint then migrates to the ACJ, distending the capsule, which we can observe on ultrasound
  • sub-acromial and sub-coracoid impingements ( if required and clinically appropriate) 

The vast majority of injuries affect the rotator cuff – 4 tendons stabilizing the joint- the supraspinatus ( most frequently affected), infraspinatus, subscapularis and teres minor.

Ultrasound can be very helpful in assessing the extent of the injury and its localizations; it can also provide information that physiotherapist then can use in planning your therapy.

Rotator Cuff Injury

Injury to the rotator cuff can be very painful and occur as a result of the degenerative process and wear and tear in the shoulder. It can also be a consequence of a sports injury or a fall.

This is why a sonographer is likely to ask you a series of questions before your scan and use the scan to confirm or rule out a pathology.  Other pathologies that are commonly found in the shoulder are:

  • Bursitis/bursal thickness—This often relates to the injury of the rotator cuff, so when we see a thickened or swollen bursa, there is a high risk of a full-thickness tear in the rotator cuff tendon. 
  • Cuff Arthropathy—a chronic condition affecting the older population.
  • Calcific tendinopathydeposits of calcium are found in the rotator cuff and may lead to pain in the shoulder. Hydroxyapatite (HA) crystal deposition disease (HADD) is well recognized; the rotator cuff is the most common site for calcium crystals to aggregate. Since this is a systemic disease, calcium may be present elsewhere, for example, in the Achilles tendon. 
  • Tendon tears and rupture—commonly seen – especially in the supraspinatus tendon
  • Tendinopathy—degenerative changes of the rotator cuff – may explain weakness and pain in your shoulder

Rotator Cuff Atrophy

In the rotator cuff, we can examine muscle bellies of the long and short head of the biceps brachi, supraspinatus, infraspinatus and teres minor. The subscapularis muscle is the only one we can’t assess ( as it is hidden between the shoulder blade and the chest wall). Healthy muscle is black, bulky and large on ultrasound. However, with muscle atrophy and fat infiltration, the image is brighter – more hyper-echoic; the muscle also gets smaller, and in most skeletal muscles, this happens usually in a symmetrical way.

The supraspinatus muscle is an exemption as we see a reduction of its superior portion first. It is important to know the sonographic anatomy and also be aware of the fat tissue/ pad between the (upper) trapezius and the supraspinatus, as the lower-laying superior part of the supraspinatus gradually disappears as atrophy sets in. This pattern helps us evaluate the muscle and its overall health. Atrophy is caused by tendon tear, neurological issues, or simply because the muscle has not been used.

Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

Examples of Shoulder Pathology

Linear calcific deposit within the supraspinatus tendon

Linear, calcific deposit within the supraspinatus tendon


Tendinopathy of the supraspinatus tendon

Tendinopathy of the supraspinatus tendon; loss of normal fibrilar pattern and echogenicity. Image in short axis


Scan of a rotator cuff tear

Supraspinatus full-thickness tear. Case courtesy of Maulik S Patel, From the case rID: 17937

Shoulder Labrum Injury

Ultrasound can only assess the labrum in the posterior joint. Pathology within the joint (inside the joint) is best assessed with an MRI. For example, a patient presenting with clicking or popping within the joint after a fall or sports injury might be better assessed with the MRI; this can allow for better visualisation of the labrum within the joint and any potential injuries like a SLAP lesion or Hill-Sachs lesion


Frozen Shoulder- Adhesive Capsulitis

Frozen shoulder affects mainly women aged 40-60. There are some characteristic features of a frozen shoulder that can be detected on an ultrasound scan. Stella et. al. (2022) explain what those features are in their interesting article. When scanning, we pay particular attention to: 

  • effusion/fluid in the long head of the biceps tendon sheath – contractures to the capsule will decrease the volume of fluid in the joint, which will then move to the biceps tendon sheath
  • positive power doppler finding of the joint capsule
  • thickening of the ligaments, especially the inferior glenohumeral ligament (IGHL) and correct – humeral ligament; measuring the thickness of the IGHL is especially useful; thickness >2mm may indicate a frozen shoulder. 
  • Reduced gliding of the infraspinatus tendon


Knee Joint Ultrasound Scan

Knee ultrasound can reveal several pathologies. If you decide to have a scan, it is likely that the following structures will be examined:

Anterior Knee – the front part of the knee, including the quad tendon, fat pad, suprapatellar recess, patellar tendon, and Hoffa fat pad. 

Medial and Lateral Knee – for signs of any meniscal pathology ( especially in the peripheral meniscus), ligamentous damage, biceps femoris injury, pes anserine bursitis

Posterior Knee – Posterior horns of medial and lateral menisci, Baker cyst, tendon insertions.

The whole knee will be assessed for any signs of degeneration, osteoarthritis, effusion, the presence of cystic changes (i.e. para-meniscal cyst) 


The medial collateral ligament is a wide band of connective tissue stretching between the medial epicondyle of the femur and running over the medial meniscus ( its deeper portion is actually attached to the meniscus). The MCL is essential to the stability of the knee along with other three ligaments.

It inserts to the tibia, but more anteriorly than you would expect. In most cases, an injury will occur in the proximal part of the ligament. Ultrasound is a great way of assessing the meniscus and helps to provide a more accurate grading of an injury. This may help and inform subsequent treatment.   

Knee Synovitis

Synovium is part of the joint capsule and is responsible for producing the synovial fluid which lubricates and nourishes the joint. However, when the synovium is affected by an inflamation, the knee joint may swell up and be painful. We can see synovitis on ultrasound scan and recommend appropriate treatment. Synovitis may have various causes and it is important to understand what is causing it. It may be due to a rhemuatological condition (i.e. osteoarhritis), or infection. 

Hip Joint

Ultrasound is a valuable tool in detecting pathology of the hip joint. All the structures outside the joint can be assessed with great accuracy if a quality ultrasound system is employed. The procedure is often broken down into three parts to assess: anterior (front) part of the hip, lateral and posterior (back of the hip).

Ultrasound can detect fluid in the joint, pathological changes to the tendons of the iliopsoas muscle, gluteus muscles around the greater trochanter, signs of bursitis. We can also detect cortical changes around the hip joint which may indicate such pathology as osteoarthritis or CAM lesion (labrum injury). 

There are three types of bursitis of the hip region:

Iliopsoas bursitis – pain will affect the front of the hip and the groin; this is the most common bursitis in this region.

Trochanteric bursitis – the pain will affect the side of the upper leg; it is less common, and in most cases, pain results from tendinopathy of gluteal tendons rather than bursitis

Ischio-gluteal bursitis – the least common type of bursitis; pain will affect the area of the ischial tuberosity and it is said to be caused by sitting with crossed legs. 

Calf Injuries

Oftentimes in sports such as football, rugby or athletics. The calf injury is the third most common injury after hamstrings and quads. The most common site is the myotendinous junction (between the muscle and tendon) of the medial head of the gastrocnemius muscle (inside of your calf); it is the so-called ‘tennis leg’. Also, injuries often occur in the gastric aponeurosis (GA) between the gastroc and the soleus. Read this article on medial gastrocnemious injuries to learn more.

Scan of an injured calf muscle

Injury of the medial head of the gastrocnemius muscle

Ultrasound is very sensitive in detecting gastroc injuries. However, it may struggle with soleus ( another main calf muscle) injuries – for those MRI seems to be a better option. Read the article by Balius, R. et al.

Deep Vein Thrombosis (DVT)

Ultrasound is a gold standard in diagnosing a DVT.  A clot in the vein can be serious, especially if it does not stay in one place, but in the form of an embolus, it moves in the venous system towards the heart and ends up in the lungs, where it can lead to pulmonary embolism. Although not really within my scope of practice, I may come across a DVT during the scanning of musculoskeletal injuries such as muscle or tendon tears or other pathologies around the knee joint. It is therefore important to identify the source of pain, and if it is a DVT, act swiftly, and refer accordingly. Patients often are put on anticoagulants but it all depends… Clots in superficial veins are not deemed dangerous unless they are in close proximity to a deep vein.

Achilles Tendon 

The strongest of all tendons in the body, the Achilles tendon is also prone to injuries. And those do not want to heal fast due to very poor blood supply to the tendon.

Physiotherapy and rehabilitation sometimes take months, and rest will not help you recover faster. Often, those in intensive training overload this tendon, especially if training is not planned sensibly. It is not rare to see patients with bilateral Achilles pain in the clinic. 

A useful patient leaflet with the exercise program for Achilles tendon tendinopathy from the Oxford University NHS Foundation Trust.

Achilles Tendon Pathology

Ultrasound is great for visualising even subtle changes within the tendon; some claim it is better than MRI. What can we see on ultrasound? What pathology can we detect? The list is long and includes also other pathologies of the posterior ankle. 

  • Achilles tendinosis—swelling of the tendon, loss of the fibrillar pattern, Achilles is becoming tender, and if there is no modification to a training plan, the pain will surely gets worse.
  • Achilles tendinitis—this term is quite controversial and has recently been replaced by broader ‘tendinopathy’. Tendinitis means that along with degenerative changes, there is also inflammation of the tendon. The problem was that specialists used this term frequently, although there was no convincing evidence for inflammation. For example, there would not be any PD (PowerDopler) signal within the tendon.
  • Achilles paratenonitis—A protective layer of connective tissue surrounds the tendon and helps it glide. Sometimes, though, this part of the tendon gets very painful, and we see fluid (black halo); below, it is clearly visible in the short and long axes.
  • Achilles tears
  • Achilles calcific tendinopathy
  • Haglund’s deformity 
  • Enthesopathy of the Achilles tendon

Haglund’s Deformity

It is a benign, bony growth at the insertion of the Achilles tendon. If irritated ( for example, by shoewear), it may cause pain. The bone spurs and Haglund’s deformity are very common and occur as a result of the tendon (or plantar fascia in the case of the bone spurs) pulling on the bone tissue, which, over time, leads to bone growth. What re-occur with Haglund’s deformity is so-called bursitis – we have two on the back of the heel. One is between the heel bone and the Achilles tendon, and the other is between the tendon and the skin. Ultrasound allows us to assess bony growth and bursae and provide the best therapy based on the findings. 


Ankle injuries can be very well assessed with ultrasound. It is advisable to leave the scan till a bit later rather than scanning straight after the injury. Scanning is usually more focused on the area of injury/pain; not like in the case of the shoulder joint where we scan the whole joint and rotator cuff.

Most common injury is the ankle inversion injury where the foot rolls outside. There are a few ligaments that stabilise the ankle on the lateral side and we often assess: ATFL, AITFL and CFL. Ultrasound gives us also a chance to test the ankle dynamically and these ligaments to check if they are intact.

On the lateral side of the ankle, we can also assess peroneus tendons (longus and brevis), which sometimes, due to tendinopathy, may swell up and cause pain on walking.

An inversion ankle injury may also cause damage to the structures of the medial ankle. There are also other injuries that may result in pain, such as tarsal tunnel syndrome, where the posterior tibial nerve is compressed (i.e. by ganglion, tendon, osteophyte). In the medial compartment, there are three main tendons that may be a source of pain: tibialis posterior, flexor digitorum longus, and flexor hallucis longus. 


Ultrasound is an excellent diagnostic tool for diagnosing musculoskeletal issues within the foot. Plantar fasciitis, capsulitis, ganglions, Freiberg’s disease, bursitis (adventitious), and Morton neuroma ( or bursa – neuroma complex) are among frequently identified problems. Morton neuroma leads to pain in the front of the foot, and on ultrasound, we can see an enlargement of the nerve.

Check if you have Morton neuroma – NHS resource


There are many small bones and joints within the wrist. There are also many tendons and ligaments that can be a source of pain.

In clinic we see three groups of patients; those presenting with more localised pain(i.e.tendinopathy), those with more generalised pain affecting the whole wrist ( i.e. in gout, OA), and patients with a nerve entrapment, i.e. carpal tunnel syndrome.

Carpal tunnel syndrome is very common, and on ultrasound, we see an enlargement of the nerve, which looks squashed under the flexor retinaculum. We always take measurement of the nerve and we suspect pathology if its size exceeds 10mm2. It is important to assess the nerve proximally and distally too. Some nerve enlargement can be seen in distal carpal canal, too.

It is rare for gout to affect only the wrist. The most common site is the big toe and the 1st metatarsophalangeal (MTP) joint. 

private scan performed by marek

Ultrasound and cross-section measurement of the median nerve in the carpal tunnel syndrome.

Wrist – ultrasound assessment

On ultrasound we can assess these structures probably even better than with MRI. Distal radio-ulnar joint, radio-carpal recess, scaphoid-lunate ligament SST joint, FCR, extensor compartments, radio-triquetrum ligament, and carpal tunnel, are some of the structures that can be well-visualized and assessed for the presence of such conditions as – nerve compression (i.e. in carpal tunnel syndrome), tendinopathy, intersection syndrome (distal and proximal), joint effusion, rheumatological conditions (i.e. osteoarthritis, gout). 

Ultrasound allows for an accurate assessment of the wrist after an injury i.e. after a fall or sport injury. There are numerous ligaments that may be torn  or strained following a fall. You may have an avulsion injury where part of the wrist bone is displaced. 

Common conditions:


Tennis or golfer elbow are the most common pathologies we detect on musculoskeletal ultrasound. These overuse injuries can be very painful and oftentimes require prolonged therapy. On ultrasound we can see a change in fibrillar pattern, cortical changes including avulsion injuries, change in echogenicity ( tendon becomes darker in places on ultrasound).

There are obviously other, less common, pathologies detectable by ultrasound, including – joint synovitis, and ligament injury ( f.e, AL, RCL, LUCL or MCL injuries). Sports injuries also can be visualised and assessed with ultrasound; the biceps tendon inserted into the radial tuberosity may have a partial-thickness tear or rupture completely.

Injuries to the brachialis tendon ( main elbow flexor) are rare. It is important to scan the context of clinical examination, as this gives the best idea as to what injury we are dealing with.

Tendon Pathology

Tendon tears – ultrasound is a great tool to detect small and large tears within tendons. 

Tendinopathy – this is really an umbrella term describing tendon pathology. Tendinosis means there are degenerative changes (wear and tear) within the tendon and sometimes it is difficult to tell apart tendinosis from a tear on ultrasound. Tendinitis is inflammation of the tendon.

Enthesitis – tendons and ligaments insert into the bone and those attachments (enthesis) can sometimes get inflamed. Power Doppler gives us an additional info about neovascularization (new blood vessels) which may suggest an ongoing inflammatory process. 

Peripheral nerve pathology

Carpal Tunnel Syndrome

The median nerve is responsible for symptoms of carpal tunnel syndrome. Its enlargement is an important indicator of the condition. The nerve often gets squashed underneath the palmar aponeurosis. Good practice is to assess the nerve while it is entering and exiting the carpal tunnel and also during more proximal scanning towards the shoulder. The normal cross-section of the nerve is between 7.0 and 10.2 mm2.

carpal tunnel syndrome and median nerve

Carpal tunnel syndrome and median nerve pathology. Swelling and change of contours of the nerve can be clearly visible on ultrasound


Schwannomas are benign, slow-growing, and often painless tumours arising from the nerve sheath. They can occur anywhere in the body at any age. Patients usually notice a lump on the skin. 

Rheumatological conditions

Ultrasound is very useful in detecting rheumatological conditions, including gout, pseudo-gout or rheumatoid arthritis. The eroded cartilage surface, crystals deposited within joints and tendons, synovial proliferation, and positive power Doppler signal are typical ultrasound findings. Find out more about gout, the most common inflammatory arthritis, from the article below.  

GOUT and ultrasound

Calcium deposition diseases

HADD – hydroxyapatite crystals deposition disease – the rotator cuff of the shoulder joint is where we commonly find calcium deposits.

Gout – calcium deposits tend to aggregate on the surface of the joints.The joint that is commonly affected is the first MTP (metatarsophalangeal joint). Swelling, redness, and pain around this joint may be signs of gout (podagra).

Pseudogout (CPPD) – calcium deposits’ location is mainly within the cartilage. Whereas gout often starts in the big toe, pseudogout tends to initially affect the knee ( especially the meniscus) and the wrist(TFCC complex on the side of your wrist)

All the above conditions can lead to pain and inflammation. 

Plain X-ray will not show gout deposits, but pseudogout and hydroxyapatite crystal deposition disease will be visualised.


Where is your clinic?

Clinic’s address: Unit 3c at 3 Hursley Road, Chander’s Ford, Eastleigh, SO53 2FW


Are there any side effects from ultrasound scanning?

No, ultrasound is very safe in musculoskeletal medicine. Due to the safety ALARA principle, we only scan as long as it is only necessary to take meaninful images.


How much is the ultrasound scan?

Ultrasound scan, physio consultation and therapy at Physio-Soton cost £129.00. 


How can I book an ultrasound scan with you?

You can book online or by calling our clinic in Chandlers Ford on 02382182416


Can my GP and I receive a scan report?

Yes, we will send the report to your email address.

Useful links

Research Articles

Further Ultrasound Scan Reading

Contact Us For A Private Ultrasound Scan



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