Diagnostic Ultrasound

Getting a clear picture of what is happening inside a tendon or joint has traditionally meant waiting weeks for an MRI referral, paying separately for a private scan, or proceeding on clinical assessment alone. Scanning in clinic removes that delay: we examine you, form a hypothesis, and test it with the probe in the same appointment.

Ultrasound is excellent for superficial soft tissue. It shows tendon thickening, hypoechoic degenerative change, partial and full-thickness tears, calcific deposits, muscle tears and haematoma, bursal swelling and effusion, ligament integrity, and nerve entrapment sites such as the carpal tunnel.

It is also dynamic, which MRI is not. We can watch a subacromial tendon glide as you lift the arm, see a peroneal tendon subluxate, or observe an impingement occur in real time. For several presentations that moving picture is more informative than a static scan.

Diagnosis becomes more specific: insertional versus mid-portion Achilles tendinopathy, a gluteal tendon tear versus trochanteric bursitis, a calcific deposit versus a purely degenerative cuff. Those distinctions change the loading programme and whether shockwave is appropriate and where to apply it.

It also gives us a baseline. Rescanning at intervals shows whether tendon structure, neovascularity or effusion is changing, which is a far better guide than symptoms alone in the slow-responding tissues.

Ultrasound has limits and we are explicit about them. It does not image bone interiors, deep joint structures, menisci, labra or cruciate ligaments reliably. Where those are suspected we refer for MRI or an orthopaedic opinion rather than stretch the technology beyond what it can see.

Imaging is one input among several. It is interpreted alongside dynamometry and force plate data, because structural change on a scan is common in people with no symptoms at all and means little without capacity testing to go with it.

Scanning findings direct dosage: which tendon, what depth, which loading mode, and whether shockwave or a referral for injection is justified.

Serial scans through a rehabilitation course, paired with strength retesting, tell us whether tissue and capacity are moving in the same direction and give a defensible basis for progressing or holding.