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

What will MSK ultrasound and musculoskeletal medicine look like in 10 years? Ryan Martin and Colin Rigney make their predictions. They start with AI assisted diagnosis: why AI will make smart clinicians smarter and expose the ones who use it poorly, why you should not rely on it 100 percent yet, and who takes the liability when an algorithm reads the image. Then robotic blood draws and needle guidance, what could replace today's injections, and why regenerative medicine will be market driven. On point of care, Colin makes the case that AI can already take a history more consistently than a human and that one appointment should send a patient home with all the answers, while Ryan pictures an AI guided ultrasound delivered to the patient's door. They close on the independent MSK clinic: same day diagnosis and treatment becoming the standard, and why corporate healthcare and the high-touch independent practice can both grow. These are the questions the speakers at the AMSKU Annual Global Summit '26 will answer on 5 December.

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

What this episode covers:

• AI assisted diagnosis in MSK ultrasound: will AI take my job?
• Why AI will make smart clinicians smarter, and expose the rest
• Will a robot replace the sonographer?
• AI guided image acquisition: a learning tool, not something to rely on 100 percent
• Who takes the liability for an AI read: the clinician or the developer?
• More progress in the next 10 years than in the last 200
• Robotic blood draws, needle guidance and what could replace today's injections
• Regenerative medicine and a market driven future
• The future of point of care: one appointment, all the answers
• AI taking the patient history, and an ultrasound delivered to your door
• Same day diagnosis and treatment as the standard for the independent MSK clinic
• Corporate healthcare vs the independent practice: two things can be true
• Coming up on the podcast: Matthew Gillogly, Marc Pietropaoli and Ariana DeMers
• Voices from the 2025 AMSKU Annual Global Summit

Links mentioned in this episode:

• AMSKU Annual Global Summit '26, Saturday 5 December 2026, live and online: see the speakers and their predictions for the next decade, register, or watch the playback from last year's summit
• Questions, comments or a prediction of your own? 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
0:23 From Probe to Practice
0:38 Episode 9: predictions for the next 10 years
1:44 Robotic blood draws and AI needle guidance
2:58 Will AI take my job? AI assisted diagnosis
4:11 AI will make smart people smarter
5:33 Will a robot replace the sonographer?
6:12 Don't rely on AI 100 percent in image acquisition
6:51 Who takes the liability for an AI read?
7:15 More progress in 10 years than the last 200
7:56 Predictions from the Global Summit speakers
8:24 What will replace today's injections?
9:14 If a robot can draw blood
9:46 Regenerative medicine: a market driven future
12:09 The future of point of care
12:48 One appointment, all the answers
13:54 An AI guided ultrasound delivered to your door
15:05 At scale, but is that what patients want?
15:46 Amazon or the human touch?
17:06 Will patients leave the house for care in 10 years?
17:22 The independent MSK clinic in 10 years
18:53 Same day diagnosis and treatment as the standard
20:33 Corporate healthcare vs the independent practice
21:08 Two things can be true
22:21 The next decade is in your hands
24:11 Coming up on the podcast
24:44 summit.amsku.com: speakers from six continents
27:21 Voices from the 2025 AMSKU Annual Global Summit

"It's so user dependent." It is the objection Ryan Martin and Colin Rigney hear more than any other about bringing MSK ultrasound into practice. In this episode they take it head on. X-rays are position dependent, MRI is reader dependent, surgery has its errors too, and every one of them is learned as a system. Ultrasound is no different: a systematic scan, enough reps with feedback, and a mentor beside you. They share how an ER physician got comfortable with a technical procedure in about 50 reps, how a resident went from no ultrasound at all in February to ultrasound guided PRP and bone marrow procedures a few months later, and why you cannot learn a hands-on skill from YouTube alone.

What this episode covers:

• Why user dependence is the objection that comes up most about MSK ultrasound
• Operator dependence in every modality: x-ray positioning, MRI reading, surgery
• Ultrasound as a system: shining a flashlight under the skin and working your checkpoints
• Plays are made to be broken, once you know the playbook
• Not operator dependent, system dependent
• How many reps it really takes: 50 and a backboard to learn from
• The road to mastery goes through incompetency
• From no ultrasound in February to ultrasound guided PRP and bone marrow procedures months later
• Why you can't learn a hands-on skill from YouTube, and why accountability matters
• The "I don't want to go back to school" mountain
• Voices from the 2025 AMSKU Annual Global Summit

Links mentioned in this episode:

• MSK Ultrasound Residency, 12 months of hands-on training with expert mentors. Book a free discovery call
• All-inclusive MSK ultrasound course memberships, with step by step video tutorials
• MSK ultrasound scanning guides and eBooks by anatomical region
• Every AMSKU course
• Tell us the objection you hear most
• AMSKU Annual Global Summit, Saturday 5 December 2026, live and online. Register, or watch the playback from last year's summit

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

Chapters:
0:00 This week on From Probe to Practice
0:25 From Probe to Practice
0:38 The objection: MSK ultrasound is too user dependent
1:45 MRI is the gold standard, and still reader dependent
2:41 A flashlight under the skin: ultrasound as a system
3:24 A handheld skill still has a system
4:08 "It's so user dependent." There's training for that
5:15 Errors in MRI, CT scans and surgery too
6:38 Plays are made to be broken
7:18 Not operator dependent, system dependent
7:38 Talking a clinician through the objection
8:04 50 reps: how an ER physician learned a technical procedure
9:02 15 orthopedic surgeons in one week
9:56 The road to mastery goes through incompetency
10:07 February to June: a resident's first guided procedures
11:25 Learning MSK ultrasound without a fellowship
12:29 A hundred books on riding a bicycle
13:14 Accountability and a residency style program
14:55 Why we welcome the objections
16:00 The mountain: "I don't want to go back to school"
16:39 Raising the standard at the point of care
17:34 Coming up: more objections, and a live Q&A
18:23 Voices from the 2025 AMSKU Annual Global Summit

How many scans does it take before MSK ultrasound starts to click? Colin Rigney and Ryan Martin get honest about their own first 100 scans: the moment Ryan nearly quit, the mentors who kept them going, and the phases every learner moves through on the ultrasound learning curve, from taking 50 pictures of a shoulder to streamlining your sequence to finally bringing real assessment into the scan.

What this episode covers:

• The ultrasound learning curve in phases: 0 to 25, 25 to 50, 50 to 75 and on to 100 scans
• Why the first 25 scans are the "what am I looking at" phase
• Don't sleep on the physics: knobology, gain, focal zone and depth from day one
• Why even a strong anatomy background gets humbled by sonoanatomy
• Building trust with a mentor, and why you cannot second guess the coaching
• Moving from technician to diagnostician between 50 and 75 scans
• A near miss: the gastrocnemius tear that looked like a Baker's cyst
• The anterior hip, the deep gluteal space, and why piriformis is not a diagnosis
• The AMSKU Annual Global Summit, Saturday 5 December 2026

Links mentioned in this episode:

• AMSKU Annual Global Summit, Saturday 5 December 2026, live and online. Early bird tickets available now: summit.amsku.com
• Introduction to Musculoskeletal Ultrasound: MSK Ultrasound Physics and Machine Optimization
• Every AMSKU course

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

Chapters:
0:00 Harder than you think
0:27 From Probe to Practice
1:20 What your first 100 scans really teach you
1:56 Behind the eight ball: when Ryan nearly quit
4:13 Mentors, and getting the nod
5:15 Why the shoulder clicks first
7:25 Don't sleep on the physics
8:29 Practicing for a job that didn't exist yet
10:34 Know your equipment
11:43 Humbled by anatomy on ultrasound
13:47 Unlearning three dimensional expectations
14:51 Old habits and trusting the coaching
15:50 Scans 0 to 25: what am I looking at?
17:46 Scans 50 to 75: from technician to diagnostician
20:37 A good plan executed sooner
21:00 50 stellate ganglion blocks: a physician's learning curve
24:34 The near miss: a gastroc tear, not a Baker's cyst
28:25 The anterior hip Bermuda Triangle
30:53 Not everything is the piriformis
32:39 The AMSKU Annual Global Summit
35:34 Raising the standard
37:59 Why we do this
38:45 Voices from the 2025 summit

Is an isolated infraspinatus tear real, or is it the zebra? Colin Rigney and Ryan Martin take apart the most heavily taught and least often seen tendon in the rotator cuff: why the infraspinatus rarely fails on its own, the two normal anatomic findings that get read as pathology, and how to tell an overlap artifact from a genuine tear.

What this episode covers:

• Why a cuff fails anteriorly to posteriorly, and what that means for your scan order
• The elongated myotendinous junction that gets called a bursal sided tear
• Cortical irregularity across the middle facet, and why it is not a Hill-Sachs
• Where the infraspinatus overlaps the supraspinatus, and the echogenicity change that fools people early in their scanning
• Anisotropy versus pathology when the two tendons sit 30 to 45 degrees oblique
• Assessing fatty atrophy in the posterior fossa, using teres minor as the landmark
• Treating the whole organ rather than one tendon

Courses mentioned in this episode:

• Live Shoulder Scanning Protocol
• MSK Ultrasound Evaluation of Rotator Cuff Tear vs Tendinopathy
• Every AMSKU course

New episodes every Tuesday. Watch on YouTube, or listen wherever you get your podcasts.

Chapters:
0:00 The zebra, and the overlap that fools you
0:20 From Probe to Practice
1:04 Why the infraspinatus, and why now
1:59 The honest reason behind the post
4:15 How often is it isolated?
4:57 The wrestler: a tear nobody predicted
5:43 Ultrasound is a tool, not the whole answer
7:01 Two normal findings that look like pathology
8:44 Where the infraspinatus overlaps the supraspinatus
9:56 Anisotropy versus pathology
11:07 Fatty atrophy and the notch of no name
12:22 Teres minor is your lighthouse
14:43 This is beyond beginner level
15:41 The courses that cover this
16:54 Treating the whole organ
19:46 The distal biceps window debate
22:37 The new machine
24:12 Wrap

"There's no shortcuts with ultrasound."

A weekend course can hand you momentum. It cannot hand you competence. Colin Rigney and Ryan Martin come off a weekend of teaching and take the question straight on: I did a weekend course, what are your thoughts?

The answer starts with intent. Where is your skill set right now, why are you adding this one, and what do you actually want to be able to do at the end of it? Two clinicians can sit at the same table for the same two days and walk away with completely different things, and the difference is almost never the course.

Then there is the objection underneath all of it. "I don't have time." Ryan's answer is that you have time, everybody has time, and what you are really describing is a priority. That answer tells you more about the intent than any registration form does.

Also in this episode: the physician assistant who is genuinely proficient at ultrasound-guided hip injections and does everything else blind; why people try to learn a new skill through the lens of how they learned the last one, and why that turns into resistance; how industry money shapes what gets taught in a big conference room, and how to find the trusted sources when you cannot tell hype from evidence; why ultrasound is the gateway to regenerative medicine and the only imaging tool that lets you assess, discuss and treat in the same visit; and what AMSKU built its own weekend immersion to do differently, with five learners, one instructor for every one to two attendees, no slide decks, and chalk talk straight to scanning.

To be clear, because the hosts are: good weekend courses exist and both of them teach at them. A weekend is a launchpad. The reps after it are the actual work.

The Monday-morning takeaway: before you book the next course, write down what you want to be able to do when it ends. If you cannot name that, another weekend will not get you there. If you can, you have just turned a course into a starting point.

In this episode:
0:00 — No shortcuts, and everybody has time
0:24 — Welcome to episode five
0:45 — Teaching the AANA workshop in Phoenix
3:30 — Ultrasound as a bolt-on to an existing practice
4:08 — Guardrails, and raising the standard
4:35 — There are no shortcuts with ultrasound
5:04 — Not one, two, or even three weekend courses
5:20 — A launchpad, or dipping your toe in
6:18 — Operator dependent, every time
6:50 — Today's question: I did a weekend course
6:59 — It all comes down to intent
7:45 — Start with the end in mind
9:00 — The elbow injection nobody had shown him
9:43 — Meet people where they are
10:10 — Proficient at the hip, blind everywhere else
11:43 — What is the real intent for going?
12:57 — Industry, money, and influence in the room
14:07 — Shiny objects, and the charlatan problem
15:13 — Finding the trusted sources
16:42 — The objections to starting MSK ultrasound
17:10 — Learning a new skill through an old lens
19:51 — Time, money, and what you actually prioritize
21:29 — Everybody has time
22:41 — The person who goes to the gym
23:35 — Ultrasound is the gateway to regenerative medicine
24:26 — Inside the AMSKU immersion: five learners
26:10 — Weekend courses are a launchpad
27:05 — The anti-weekend course
28:46 — Good weekend courses do exist
30:35 — No slide decks, chalkboard to practice
33:46 — Where to start: select.amsku.com
35:03 — The Diagnostic Awakening
35:56 — Sign-off

Mentioned in this episode:

AMSKU Select, the weekend immersion both hosts describe as the anti-weekend course — five learners, one instructor for every one to two attendees, 13 hours of guided scanning, in Mesa, Arizona: https://select.amsku.com
Introduction to Musculoskeletal Ultrasound — the online course to start with if time or bandwidth is the real constraint right now: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/
The Diagnostic Awakening — Colin and Ryan on how they got here, and what integration actually took: https://awakening.amsku.com

New episodes every Tuesday.

From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

"How do you know what abnormal is if you don't know what normal is?"

Every tissue has a signature. Bone is bright white. Tendon and ligament are fibrillar, like a guitar string. Nerve in short axis is a bundle of grapes, or a honeycomb. Muscle is sinuated and feathery. Fat is marbled. Learn those cold and pathology announces itself, because pathology is a departure from a picture you already hold.

Skip that step and the screen will hand you a diagnosis you invented. Tip the probe a few degrees and a normal tendon goes dark, and dark reads as pathology. As Ryan Martin puts it, you check the contralateral side, you do everything right, and really all it was was a difference in how you held the probe.

Colin Rigney and Ryan Martin spend this episode on reading echo texture and the pattern recognition underneath it. Also in this episode: how to tell nerve from tendon when they look identical in short axis (make the tendons glide and watch what stays still), how to separate a fat pad from the quad tendon by pushing on the skin, the three questions Colin asks at every tendon-bone interface, why a cortical change on the infraspinatus means something different from the same change on the supraspinatus, the little dip before the enthesis that will let you invent a tear at the critical zone, and why an isolated infraspinatus tear is rare enough to make you look again.

The Monday-morning takeaway: before you grade anything, ask whether you have seen enough normal of that exact tissue to know what you are looking at. If the answer is no, that is not a reading problem. That is a reps problem.

In this episode:
0:00 — Thirty scans a week, and why reps win
0:32 — Hosts, dogs, and a drive to Tempe
2:02 — Welcome to episode four
3:59 — Today's topic: reading echo texture
4:41 — Start with the machine, not the anatomy
4:59 — Echogenicity, and 256 shades of gray
5:37 — What each tissue should look like
6:11 — Know normal, then judge the departure from it
7:20 — Echo texture can lie to you
8:06 — Anisotropy: the same tendon, two pictures
9:01 — Telling nerve from tendon in short axis
9:58 — Tendons glide, nerves stay still
10:48 — Fat pad or quad tendon? Push on the skin
11:55 — Grading the departure from normal
12:50 — Why we start with the shoulder
13:24 — Three questions at the tendon-bone interface
14:15 — Not all cortical changes are equal
16:04 — Fooling yourself at the critical zone
16:38 — Rarely an isolated infraspinatus tear
17:46 — In clinic, the first thing you see is abnormal
18:33 — The limiting factor is how many scans you do
19:53 — Tendinopathy or tear: what to look for
21:47 — Google will not teach you this
23:18 — Reading echo texture is the foundation
25:47 — Thirty scans this week
27:29 — Where to start if you are new
29:01 — Course links and sign-off

Mentioned in this episode:

MSK Ultrasound Evaluation of Rotator Cuff Tear vs Tendinopathy — Ryan's case-study course on grading tendinopathy and telling it from a tear. 1.0 AMA PRA Category 1 Credit: https://www.amsku.com/courses/musculoskeletal-ultrasound-evaluation-of-rotator-cuff-tear-vs-tendinopathy-with-case-studies/
Introduction to Musculoskeletal Ultrasound — the physics, machine optimization and normal sonoanatomy course Ryan points to when he says start with normal: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/
Free shoulder e-book, if you want somewhere to start at no cost: https://zfrmz.com/RwwBmQJTGwgnyUJItYdy

New episodes every Tuesday.

From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com