Introduction
Ultrasound imaging can be on par with MRI for certain pathologies in skilled hands. An inexpensive handheld unit like the Suresult D3Ultra can diagnose some of the most common pathologies without referring out for MRI.
But even if you have access to a unit, it is intimidating. I would argue that the MSK specialty is the most challenging specialty as you have to be familiar with so many different structures and so many different pathologies.
But as a point of care practitioner you don’t have to learn every structure and every pathology to get started. You just have to learn enough to answer a clinical question. If you start by limiting the scans to very specific problems/questions/protocols (<5min including set-up) for very specific conditions you will improve diagnostic accuracy and can more confidently suggest a specific treatment plan and give a better idea of prognosis.
This will improve the patient’s impression of you and your clinic. The protocols below are chosen to maximize patient impression, simple for doctors to learn, and include some of the most common conditions. Once mastered and with some experience under your belt, you can then start learning more structures and pathologies.
Beginnier MSK POCUS Scans: Elbow Achilles
These scans include which pathologies to check for and optional structures. We are basically starting with 3 tendinopathies. The first two look pretty much identical just on either side of the elbow. The last is the single largest tendon. The elbow attachments take up the upper half or more of the sloped surface of the epicondyle. You can use splitscreen and compare the asymptomatic side with the symptomatic side. Look for fiber disruption, if it is thickened, and/or if it is abnormally hypoechoic.
1. Medial Elbow (Golfer’s elbow, medial epicondylitis, etc…)
Views
- Common flexor tendon in long axis with partial view of the UCL underneath.
- For tendinopathy: enthesitis, tendinosis, tendon tear.
- Look for abnormalities in the UCL (partially seen under the common flexor tendon).
Optional Views
- UCL in long axis with or without valgus stress test.
- If it is a throwing athlete or with an acute injury or if the UCL looks abnormal, the transducer should be rotated to view the UCL in long axis and a valgus stress test may be warranted.
- Looks for a tear, complete rupture, or irregular fibers (scar tissue).
2. Lateral Elbow (Tennis Elbow, Lateral Epicondylitis, etc…)
Views
- Common extensor tendon in long axis.
- For tendinopathy: enthesitis, tendinosis, tendon tear.
Recommended Optional View
- Scan through the extensor muscles looking for hypoechoic nodules indicating myofascial trigger points (MFTP).
- Confirm if the point reproduces the patient’s pain by applying pressure with palpation. Can sometimes be treated within minutes via ischemic compression. Palpate and/or scan the pronator teres for MFTPs too.
3. Achilles and Posterior Heel
Views
- Long axis achilles
- For tendinopathy: enthesitis, tendinosis, tendon tear, bone spurs, haglund syndrome.
- Additional bursal fluid might be deep to the tendon or superficial to the tendon/calcaneus.
- Sweep through the achilles in the short axis too.
Optional Views
- Tibialis posterior tendon just posterior to the medial malleolus.
- If the patient’s pain/tenderness is more medial or if the patient also has arch pain.
Catch Up on the Full Beginnier MSK POCUS Series
This is Part 1 of our beginner-friendly MSK POCUS guide. To build a comprehensive diagnostic skillset, don’t miss the rest of our MSK POCUS series designed for primary care:
- Part 1: Shoulder, Knee, & Foot Scans (You are here)
- Part 2: Elbow & Achilles Tendon Scans
- Part 3: Nerve, Ankle, & Fracture Scans
Conclusion:
This gets you started with some very easy tendons to practice with and all 3 tendons are commonly painful and you can look like the professional by getting a nice picture, maybe do split screen so you can see the pathologic side versus the normal side, label it, and put it in your soap notes or even practice writing a report.
Share it with the patient and when you refer out and then you can scan at the follow up assessment to show the patient the improvement or lack of improvement. I do offer a robust educational program, but also keep an eye out for future posts here with simple scans you can start implementing today.
References:
- Ramakko, B. (n.d.). MSK POCUS training. Dr. Ramakko’s Ultrasound Training. Retrieved December 28, 2025, from https://msk-pocus-training.trainercentralsite.com/
- Ramakko, B. (2025, August 14). Suresult ultrasound evaluation for tennis elbow – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=HYUolYyx36I
- Ramakko, B. (2025, August 24). Suresult ultrasound evaluation of the Achilles tendon – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=wE1XIlN19hM
- Ramakko, B. (2025, September 4). Suresult ultrasound evaluation for tibialis posterior tendinopathy – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=DUlW03vXCJQ
- Ramakko, B. (2025, October 19). Suresult ultrasound to look for golfer’s elbow – medial epicondylitis – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=UOAAO2c4fB0
- Ramakko, B. (2025, October 21). Suresult ultrasound to look at the elbow UCL: Tommy John injury – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=R0Uq0UgjccY
- Suresult. (n.d.). D3Ultra multipurpose handheld ultrasound for doctors. Retrieved December 28, 2025, from https://suresultmed.com/shop/handheld-ultrasounds/d3ultra-multipurpose-handheld-ultrasound/
