A 76 year old lady was referred from orthopaedics following a fall onto their shoulder 1-month previously. Initially seen in the Emergency Department X-ray had demonstrated no fracture. The patient's main complaint was weakness with normal everyday activity.

Ultrasound demonstrated a rupture of the supraspinatus tendon which is not an uncommon finding. However, examination also demonstrated a complete rupture of the tendon of infraspinatus with associated swelling noted in the posterior aspect of the glenohumeral joint extending around the proximal stump of the tendon. A much less commonly noted finding.

A 48 year old male patient with 6 month history of shoulder pain. Onset had been insidious with no initiating trauma. The patient worked as a carpenter and was struggling having been forced to take several occasional days off work. His G referred him to Orthopaedics. An x-ray was unremarkable. A diagnosis of frozen shoulder was made and after little improvement with a course of rehabilitation the patient was referred for an ultrasound guided hydrodistension of the glenohumeral joint.

Examination revealed a clear capsular restriction in range of movement. Lateral rotation - 20 degrees; glenohumeral abduction 30 degrees.

Ultrasound examination was unremarkable.

After consenting the glenohumeral joint was injected using a posterolateral approach with 40mg Depomedrone, 5mls 1% local anaesthetic and 30mls normal saline.

Immediately post-injection range of movement had improved. Lateral rotation - 40 degrees; glenohumeral abduction 70 degrees.

The patient was advised on immediate continuance of their programme of rehabilitation.

The images demonstrate needle placement into the posterior aspect of the glenohumeral joint. The needle can be seen (yellow arrows) and the saline injected (blue curved arrow).

The patient was a 60 year old keen power lifter who felt a sudden tearing sensation while bench pressing. The US demonstrates a clear complete rupture of the subscapularis tendon.

The patient presented with a 6 month history of right frozen shoulder. This had failed to respond to conservative treatment including exercise and an injection of corticosteroid.

After consenting and using a posterolateral approach the glenohumeral joint was injected with 40mg Depomedrone, 10mls 1% lignocaine and 30mls normal saline.

During the injection the capsule maybe seen to stretch and then suddenly release as adhesions are ruptured. The patient noted an improvement in range immediately post injection of some 40 degrees abduction. In this video the needle is just off the left side of the video.

The patient described an insidious onset of right sternoclavicular joint pain over several months duration. Examination demonstrated pain towards end of range shoulder movements in all directions. A prominent and tender right sternoclavicular joint was noted.

Ultrasound demonstrates marked cortical irregularity of the right sternoclavicular joint particularly at the proximal clavicle (Fig.1 Curved arrow). In addition there appears to be marked joint hypertrophy which on Power Doppler demonstrated a florid synovitis (Fig. 2).

The patient presented with an 8-month history of frozen shoulder. Conservative rehabilitation had failed to date. An injection was undertaken after consenting using a posterolateral approach with 40mg Depomedrone 10mls 1% lignocaine and 30mls of saline. The needle maybe seen to approach the posterior aspect of the glenohumeral joint to sit just below the posterior labrum.

After initial injection of the Depomedrone and lignocaine the joint is injected with saline. The posterior capsule maybe seen to stretch away from the posterior humeral head.

This transverse image at the level of the metatarsal heads demonstrates a low echo foci between the 3rd and 4th metatarsal heads moving in a plantar direction when the metatarsal heads are squeezed together - A positive Mulder's Click. The image is classic for a Morton's Neuroma

This longitudinal image through the tarsal tunnel at the medial ankle joint demonstrates well the difference in appearance of tendon, nerve and blood vessel. The great toe is being flexed and extended and the deepest structure on the image the tendon of flexor hallucis longus (FHL) can be seen to glide freely in the tunnel. The overlying tibial nerve (N) appears of courser appearance and remains static. The most superficial structure is the posterior tibial artery (A).

46 year old female distance runner. Recently changed to a very low profile unsupportive running shoe during the build up to a Marathon. Within 2 weeks she noted quite severe medial ankle pain and was unable to continue training.

Ultrasound demonstrated a marked tenosynovitis with synovial thickening within the tibialis posterior tendon sheath around the posterior aspect of the medial malleolus. The tendon itself demonstrated no evidence of significant tendinopathy or tear.

Treatment consisted of analysis of foot position and gait. A pronated foot type being noted. A more supportive running shoe was advised with a relatively rigid mid-sole. Orthotics were supplied for everyday footwear to off-load the tendon.

In addition after consenting and under ultrasound guidance the tendon sheath of tibialis posterior was injected with 25mg hydrocortisone and 5mls 1% local anaesthetic.

The patient was advised on a slow return to running in 1 week. They were unable to complete the Marathon but within 1 month had increased their running to previous levels.

Longitudinal view of a normal plantar fascia. This video clip demonstrates a stress test of the fascia testing for partial or complete rupture. The fascia in this clip can be seen to be intact.

38 year old male. Mixed martial artist. Right thumb twisted while fighting 4 weeks previously. Attended the Emergency Department and advised on rest and ice. XR taken no bony injury.

1 month later pain persisting and attended our Sports Medicine Clinic. Examination revealed tenderness around the ulnar aspect of the right thumb metacarpophalangeal joint with a feeling of increased laxity.

Ultrasound demonstrated a rupture of the supraspinatus tendon which is not an uncommon finding. However, examination also demonstrated a complete rupture of the tendon of infraspinatus with associated swelling noted in the posterior aspect of the glenohumeral joint extending around the proximal stump of the tendon. A much less commonly noted finding.

Transverse view of the lower third of the extensor compartment of the forearm demonstrating a normal proximal intersection. The tendons of abductor pollicis longus and extensor pollicis brevis can be seen crossing the tendons of extensor carpi radialis longus and brevis. There is no evidence of pathology.

Transverse view of the dorsal compartments of the wrist at the level of the distal radius. The tendon of extensor pollicis longus can be seen as it leaves the 3rd dorsal compartment to the left of Lister's tubercle and crosses the tendons of extensor carpi radialis logus and brevis in the second dorsal compartment.

This video is taken with the ultrasound probe over the internal oblique, external oblique and transverse abdominus muscles. (diagram below). The patient had a chronic mechanical back pain with poor activation of the trunk stability muscles. Ultrasound was used to give the patient feedback allowing better activation of the transverse abdominus muscle.

When correctly engaged the transverse abdominus may be seen to contract below the external and internal oblique muscles. When incorrectly engaged all three muscle layers appear to contract equally.

Transverse view of the medial patellofemoral joint demonstrating a large bony loose body (note acoustic shadowing).