Luke Millward @MillwardLuke
Physiotherapist & MSK Sonographer | Obsessed with diagnostic imaging & US-guided injections 💉 | Shoulders | Hips | Foot & Ankle 🦶 | Reports & second opinions London & Cambridge, UK Joined April 2017-
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Asking a patient to move whilst completing a diagnostic ultrasound scan can show so much. The AC joint is a good joint to assess dynamically. In this example the AC joint can be seen to close in on itself pushing fluid cephalically. #diagnosticultrasound #shoulderpain #ACJ
A long distance runner who refuses to give up running and has tried physiotherapy, a progressive loading program and shockwave therapy. Good candidate for PRP? #diagnosticultrasound #proximalhamstringtendinopathy #buttockpain
The subscapularis tendon showed a subtle deficit, seen as a loss of fibre patterning and sagging of the anterior aspect of the tendon at its insertion. This tear was just enough to disrupt the long head of bicep sling causing it to medially sublux. #shoulderpain #longheadofbicep
This mixed echogenic heamatoma is located within the subcutaneous tissue superficial to the medial joint line. I was unable to aspirate. How would you manage this? #diagnosticultrasound #kneepain #heamatoma
Pectoralis major tendon insertional calcification While Calcific tendinopathy of the rotator cuff is common, pectoralis major tendon insertional calcification (hydroxyapatite crystal deposition disease (HADD) is much more rare.#ShoulderPain #CalcificTendinopathy #Hydroxyapatite
The deepest fibres of supraspinatus are actually part of the glenohumeral joint capsule and so when a full thickness tear the capsule of the joint is torn allowing joint fluid to escape through the tear and into the bursa. #shoulderpain #diagnosticultrasound #rotatorcufftear
This patient has both a painful triggering of the finger and a stiff and painful PIPJ. My thought is, if the joint is involved then treat the joint first. What do you think? Which one would you treat first? #diagnosticultrasound #triggerfinger #PIPJOA #fingerpain
Rec fem tears are a tricky one to diagnose and treat. In this case the central tendon seems to be torn mid thigh. Mechanism of action- full sprint during football followed by a power strike if the ball. #diagnoaticultrasound #rectusfemoristendontear #thighpain
Mulder’s click sign is a great clinical diagnostic tool used to help diagnose a Morton’s neuroma but have you tried the sonographic Mulder’s click sign? #diagnosticultrasound #probeskills #Muldersclicksign #Mortonsneuroma
The supralateral patella is often overlooked when assessing the knee for effusions and well worth a look. Often with patients presenting with fat pad involvement a small effusion can be seen under the lateral retinacular at this location? #kneepain #diagnosticultrasound #fatpad
A young lady came into clinic after falling off a metal bunk bed whilst travelling 3 weeks ago. Ultrasound showed a distal tear of the VMO from the medial retinaculum! I have never seen this injury before. Anyone else? #diagnosticultrasound #kneepain #VMO
How would you treat a raging, acute lateral tendinosis /tendinosis like this? #Tenniselbow #tendinitis #diagnosticultrasound
This is a classic example of lateral knee OA with an associated synovitic flare including, joint space narrowing, meniscal extrusion/maceration, osteophyte formations and synovitis on doppler. #OAknee #Arthosamid #Hyaluronicacid #synovitis #diagnosticultrasound #USGI
A common mistake I see when mentoring clinicians, on there ultrasound journey, is to call a tear without seeing it in only one plane. To be confident in calling pathology you need to see it in both long and short axis #diagnosticultrasound #probeskills
Scanning a traumatic injury can lead to fascinating discoveries, often revealing uncommon pathologies not typically encountered in a routine clinic setting. This ultrasound image revealed a partially severed flexor carpi ulnaris tendon #DiagnosticUltrasound #FCU #WristPain
This patient suffered from a non traumatic complete long head of bicep rupture. Imaging also shows an anechoic intraarticular effusion within the sheath (coming from the GHJ) and synovial proliferative sheath changes. #shoulderpain #longheadofbiceprupture
How often do you see a tibial avulsion fracture associated with a posteriomedial ankle impingement? Good candidate for a drop of steroid to calm the hyperaemia down followed by an onward referral to a podiatrist? #diagnosticultrasound #footpain #avulsionfracture
This distal radioulnar joint an essential place to scan for RA synovitis. You can often pick up subtle changes at this joint and is one not to miss. hashtag#rheumatoidarthritis hashtag#distalradioulnarjoint hashtag#wristpain hashtag#synovitis hashtag#diagnosticultrasound
An interesting dorsal talonavicular joint injury! This image shows a shearing of an osteophyte which has also become displaced. Seen this before? #diagnosticultrasound #footpain #avulsionfracture
In this image you can see a sheath effusion surrounding the EPB tendon only, suggestive of an internal septum. This is important when considering a guided injection! #diagnosticultrasound #dequirvainstenosynovitis #thumbpain
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