The adage goes ‘when you hear hoofbeats, think of horses not zebras.’ In other words don’t ignore the base rate of what is most likely given the presenting clinical symptoms. And subsequently many clinicians will gravitate toward the most probable diagnoses of gluteal tendinopathy or trochanteric bursopathy in patients presenting with anterolateral hip pain.

The trouble is we know that zebras do exist, and uncommon clinical entities do occur. So how do we ensure that we don’t inherently overlook those instances where the hoofbeats are in fact the zebra in patients presenting for a hip ultrasound?

This presentation discusses the less common findings which can be encountered on routine hip ultrasound when we think beyond the gluteal-trochanteric bursa apparatus. Key discussion points are validated through the presenter’s own case studies, with an emphasis on the anatomical considerations and clinical presentation of the less common hip pathologies.

All knee ultrasound exams will assess the supra-patella recess. Most will extend this to the medial and lateral patella recesses. A knee effusion is an important diagnosis. Whilst the ultrasound may not find the intra-articular cause of the effusion, it can move the patient on to MRI for a complete diagnosis.
Anatomically there are many more synovial recesses of the knee. Most sonographers will have seen many small areas of fluid around the knee and some of these get to the worksheet. They are also seen on MRI of the knee and all have names to describe them.
This presentation will review all the recesses. It is important with any fluid seen around the knee to diagnose it correctly as joint fluid compared to say bursal fluid or a cyst, or hypo-echoic synovium.

Feet are notorious for being a minefield of pathologies and navigating the region takes time, knowledge, and clinical expertise. This presentation aims to explore the wide range of pathologies when presented with a foot ultrasound referral exploring everything from navigating the intermetatarsal space, hallux pathologies to midfoot OA and how to extend your scan when the clinical asks for the famous 'plantar fascia'.

Introduction: Ruptured Achilles Tendon (RAT) is prevalent to athletic adults and the most convenient treatment is surgical intervention. This is a case study of a 26-year-old male who presented in the department in an Aircast boot for an Ultrasound (US) scan of the AT. He had sustained an injury during a hockey game 5 days ago and Thompson’s test was positive. A high grade AT tear was evident in his initial US. Instead of the usual surgical intervention recommended by his specialist, the patient opted for conservative management (CM).
Method: A total of 4 US exams were performed at an interval of 2-3 weeks from the initial stage of injury. Greyscale and doppler images to document the tear and cine loops of the injured tendon with dorsiflexion and plantarflexion maneuvers were recorded to demonstrate the morphological and functional changes of the AT.
Results: Serial US shown increased neovascularisation of the AT with more defined fibular pattern, likely due to the healing activities. Tendon movement is more concomitant with maneuvers.
Conclusion: The findings of serial of US played a significant role in influencing clinician’s decision to discharge the patient in this CM plan.
Take home message: The role of US in the evaluation of the functional performance of AT is debatable, however it can influence the clinical decision-making process in the CM of RAT. US technical parameters can be improved to ensure consistent and accurate documentation of the sonographic changes of the AT and the involved muscles in follow-up US examinations.