Luke Millward

Physiotherapist & MSK Sonographer | Obsessed with diagnostic imaging & US-guided injections 💉 | Shoulders | Hips | Foot & Ankle 🦶 | Reports & second opinions

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

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

[Luke Millward @MillwardLuke]

Pathology affecting the 5th metatarsal region is a common clinical presentation. Ultrasound imaging is perfectly placed, alongside a clinical assessment for diagnosing pathology in the lateral foot.

[Luke Millward @MillwardLuke]

It always amazes me how big some pre patella bursa’s can get! OUCH!!!!
#kneepain #diagnosticultrasound #prepatellabursa

[Luke Millward @MillwardLuke]

Colloidal aggregates are clusters of small particles suspended in the synovial fluid within the cyst. These aggregates can develop for many reasons including;
1. Increased inflammatory markers
2. Mechanical Shear Forces
3. Chronicity

[Luke Millward @MillwardLuke]

SGHL tear, cortical irregularity of the humeral head and intraarticular synovial proliferative changes within the joint space. Furthermore, there was a full thickness tear of supraspinatus and a large anechoic effusion within the bursal plane. Beautifully seen with ultrasound

[Luke Millward @MillwardLuke]

50-year-old runner came into clinic after tripping over a thorny bush.
Ultrasound found an arrow shaped foreign body buried within the Achilles! She was send for emergency surgical removal as this was seen as a dirty wound. Amazing what you can find with ultrasound.

[Luke Millward @MillwardLuke]

What could be more satisfying than a good Barbotage Lavage!
I see lots of patients with Calcific Supraspinatus Tendinopathy but it’s the ones where the calcific foci start to infiltrate into the subacromial bursal space that become super painful.

[Luke Millward @MillwardLuke]

When your shoulder scan starts with a huge amount of anechoic fluid within the sub acromial space it can only mean one thing. A massive rotator cuff tear resulting in an effusion emanating from the glenohumeral joint collecting on the bursal plane!

[Luke Millward @MillwardLuke]

Some joints, like the TMT joints of the foot, can be very difficult to inject using an in-plane needle approach. Using additional gel (stand-off technique) gives you space and allows you to get the angle right before entering the skin.

[Luke Millward @MillwardLuke]

The key is to a successful barbotage is keep the needle within the calcific foci. Going straight through can cause you to lose the negative pressure necessary to suck out the calcific debris.

[Luke Millward @MillwardLuke]

A reliable method of assessing for carpal tunnel syndrome is by measuring the diameter of the median nerve at the level of the pronator quadratus muscle and comparing it to the diameter of the median nerve at the level the lunate. diagnostic ratio of 1:4

[Luke Millward @MillwardLuke]

Chondroprotection has been widely reported as the key attribute associated with HA.

[Luke Millward @MillwardLuke]

Tibialis posterior pathology can be tricky to treat. Ultrasound imaging is excellent at helping us to unpick the underlaying causes of the patient’s pain. How would we treat this case?

[Luke Millward @MillwardLuke]

Carpal tunnel has to be caused by something! In this case an FCR sheath effusion
#ultrasoundguidedinjections #diagnosticultrasound #carpaltunnel