MRI is the gold standard most doctors train on, so why do so many who know they should adopt MSK ultrasound still hold back? Ryan Martin and Colin Rigney take on two topics they know can get heated. First, the $2,000 coin flip: the intimidation factor nobody wants to admit, imposter syndrome and the mythical finish line, and why the road to mastery goes through incompetency. Then the cases: a labral tear that two MRIs called negative and dynamic ultrasound found, an athletic pubalgia patient whose MRI came up clean, why abdominal wall tears hide on a static scan, and what the 2009 de Jesus study found for rotator cuff tears. MRI and ultrasound are complementary tools, and the skill is knowing which one to use and when. Second, palpation theater: "my hands are history enough", why precision is the most important lever in needle-guided orthobiologics, and the question to ask any clinician who relies on special tests alone: why would you not want that information?

Register for the AMSKU Annual Global Summit '26, Saturday 5 December 2026, online

What this episode covers:

• The $2,000 coin flip: why MRI is the gold standard in training
• The intimidation factor nobody wants to admit
• Imposter syndrome and the mythical finish line
• The road to mastery goes through incompetency
• A labral tear two MRIs missed and dynamic ultrasound found
• Athletic pubalgia: when the MRI comes up clean
• Operator dependent: you have to know how to elicit it
• The 2009 de Jesus study: ultrasound, MRI and MR arthrography for rotator cuff tears
• MRI and ultrasound are complementary: know which tool to use and when
• Palpation theater: are special tests and your hands enough?
• Precision in needle-guided orthobiologics
• Ultrasound is a flashlight: why would you not want that information?

Links mentioned in this episode:

• AMSKU Annual Global Summit '26, Saturday 5 December, online. Register or watch last year's playback
• Questions or comments? Reach us
• Every AMSKU MSK ultrasound course

New episodes every Tuesday. Watch on YouTube, or listen on Spotify and Apple Podcasts.

Chapters:
0:00 This week on From Probe to Practice
0:24 From Probe to Practice
0:39 Episode 11: the $2,000 coin flip and palpation theater
1:03 The $2,000 coin flip: MRI is the gold standard in training
2:35 The intimidation factor nobody wants to admit
4:14 Imposter syndrome and the mythical finish line
4:33 The road to mastery goes through incompetency
5:39 Which camp are you in? MRI or ultrasound
6:22 Case: a labral tear two MRIs missed
8:45 MRI missed it, dynamic ultrasound found it
9:14 Case: athletic pubalgia and a clean MRI
10:27 Operator dependent: you have to know how to elicit it
11:29 Why abdominal wall tears hide on MRI
12:35 A high level exam for the lower abdominal wall
14:01 The 2009 de Jesus study: rotator cuff tears
15:43 Ten minutes at the point of care
16:28 Complementary tools, not either or
17:18 ACR guidelines and clinical reasoning
18:54 Ryan's Arizona problem
19:45 Palpation theater: are special tests enough?
20:44 "My hands are history enough"
21:14 Precision in needle-guided procedures
23:01 How to start the conversation with clinicians
23:29 Ultrasound is a flashlight
24:14 The surgeon who scanned like he operated
25:28 Meeting people where they're at
26:36 AMSKU Annual Global Summit '26
28:01 Watch last year's summit playback