3 Beginner MSK POCUS Scans You Can Implement Today:  Shoulder, Knee & Foot (Part 2 of a 3 Part Series)

Introduction

This is a followup to our Beginner MSK Series which starts you off with elbow and achilles pathologies.

Here, we are going to tackle a few more challenging structures, but you only have to evaluate them to the point of answering your clinical question. You don’t have to master all the structures of the knee or the shoulder to get an idea of the state of the cartilage/osteoarthritis or to identify a large supraspinatus tear. Once these scans are mastered, and with some experience under your belt, then you can then start learning more structures and pathologies.

Beginnier MSK POCUS Scans (Part 2)

These scans include which pathologies to check for and optional structures. In this article we are checking 2 relatively complex structures, plus just a quick look at the plantar fascia.

For the complex structures, we are simplifying our scan to ask simple questions.

For the shoulder, is there a large or complete rotator cuff tear we should refer for surgical consult. We would also see fluid in the bursa which we could aspirate greatly improving the patients pain and range of motion (ROM).

For the knee we are checking for joint effusion and osteoarthritis. Large fluid collections, the state of the cartilage, and whether there are osteophytes basically is superior to the typical radiograph referral for osteoarthritis.

For the plantar fascia, we can use a simple cut-off thickness to diagnose a pathology at the most common location of pathology, right at the medial tubercle of the calcaneus. If the plantar fascia is thickened, and/or if it is abnormally hypoechoic, there is plantar fasciitis.

Remember you can always use split screen to compare sides and as you improve your skills and experience you can add structures and answer more clinical questions.

In the sample scans below I am again using the 결과 D3Ultra which is totally adequate to answer our main clinical questions and just a fraction of the cost of a laptop or cart based unit. Make sure the focus points are close to your point of interest. Turn up gain for a brighter image. Turn off compound imaging to get a better frame rate or turn it on for better looking pictures. Similarly, higher frequency will give higher resolution but lower frequency increases penetration, particularly important for the plantar fascia. Experiment with settings and practice, practice, practice.

1. Anterior Shoulder (Supraspinatus Tendinopathy, Impingement Syndrome, etc…)

Views

Biceps in short axis, then long axis (in long axis remember to heel-toe the transducer to get the fibers perpendicular to the sound beam.

• Hypoechoic indicates tendinopathy.
• Fluid in the tendon sheath is most likely an indication of a medium to large rotator cuff tear.
• (Optional) rotate the patient’s arm to evaluate the subscapularis in long axis and for biceps dislocation.

In a modified crass position (patient’s arm in extension), sweep through the supraspinatus in long axis, if any abnormality, repeat in short axis.

• Hypoechoic indicates tendinosis or tear.
• Fiber disruption indicates tear.
• Cartilage interface sign indicates tear.
• Loss of normal convex shape indicates a large tear.
• Bursa is above the tendon, don’t mistake the bursa as the tendon. Bursa may be thickened associated with impingement syndrome.

Have patient abduct the arm and observe in the coronal plane.

• Look for the edge of the superior facet to collide with the acromion for impingement syndrome.
• Look for fluid to collect in the bursa. If there is a lot of fluid then aspirate.

2. Knee (Osteoarthritis, Meniscus Tear, Tendinopathy, etc…)

Views

Quadriceps tendon in long axis

• Fluid in the suprapatellar recess indicates effusion.
• Abnormalities in the tendon indicateindicates tendinopathy. Sweep the tendon thoroughly if tender, it is quite broad.

Patellar Tendon in long axis (optional if it is tender of the patient reports pain close by its path).

• Abnormalities indicateindicates tendinopathy.

With knee flexed evaluate cartilage in short-axis/transverse plane (optionally in long axis/sagittal too).

• Evaluate state of the cartilage to stage degenerative changes.
• A worn out medial condyle but an unused lateral condyle could indicate an imbalance between the vastus lateralis and vastus medialis.

Medial Knee in long axis (coronal plane).

• Osteophytes and meniscus extrusion and limited joint space all indicate degeneration.
• A cleft in the meniscus indicates meniscus tear. Meniscus extrusion also suggests a tear (likely degenerative). Ultrasound is not reliable for ruling out meniscus tears – if you see one, you see it, but otherwise, rely on your orthopedic tests and/or refer for MRI.
• (optional) MCL if tender to evaluate for tear.
• (optional) pes anserine tendons if tender to evaluate for tear, bursitis, or tendinopathy.

Optional Views

• Posterior knee for baker’s cyst.
• Lateral knee if you suspect lateral knee pathology – to the ability of the clinician.

3. Plantar Fascia

Views

Long axis view of the medial tubercle

• Measure thickness, if >4mm diagnose plantar fasciitis/fasciosis. Thickened and hypoechoic fascia indicates plantar fasciitis/fasciosis

Optional Views

• Scan through the plantar surface
  • Look for normal fascia
  • Look for abnormal hypoechoic nodules in the plantar muscles indicating MFPTs.
• Scan tibialis posterior tendon in long axis from posterior medial malleolus to the navicular.
  • Look for tendinopathy
  • If there is tendinopathy, spring ligament is probably also injured if there is arch pain.

Catch Up on the Full Beginnier MSK POCUS Series

This is Part 2 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
• Part 2: Elbow & Achilles Tendon Scans (You are here)
• Part 3: Nerve, Ankle, & Fracture Scans

Conclusion:

This gets you started with some very easy scans to practice, 2 of which in very complex regions. Remember you can add more clinical questions and structures as your skills and experience improve. You can look like a 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 the third post in this 3 part series with even more scans you can start implementing today.

References:

1. Ramakko, B. [Brandon Ramakko]. (2025, September 3). Suresult ultrasound evaluation for plantar fasciitis / fasciosis – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=uAewXolsK7g
2. Ramakko, B. [Brandon Ramakko]. (2025, November 29). Suresult ultrasound to check a shoulder for a supraspinatus tear – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=P3rC9b5YooQ
3. Ramakko, B. [Brandon Ramakko]. (2025, December 21). Suresult ultrasound to check a knee for effusion and arthritis – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=_voYOj8fKjo
4. Ramakko, B. [Brandon Ramakko]. (2025, December 26). Suresult ultrasound to check various knee structures – 11% off with code “POCUS11” [Video]. YouTube. https://www.youtube.com/watch?v=o06zEYqG3ag
5. Ramakko, B. (2025, December 28). 3 beginner MSK POCUS scans you can implement today (Part 1 of a 3 part series). Suresult. http://suresultmed.com/beginner-msk-pocus-scans-elbow-achilles/