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High volume saline injections are used for recalcitrant mid portion achilles tendinopathy 🦶🏽 But what volume of saline do you use ? 10, 20, 30 or 40ml? Or do you use even more! And does it matter? Consent ✅️

And here is my "formula" for volume depending on the neovascularisation grade Grade 1 = 10ml Grade 2 = 20ml Grade 3 = 30ml Grade 4 = 40ml I always check for neovessels after the injection and if any remaining will top up until none left

The comments on this post got me dying 🤣

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Consent ✅️ Referred by APP for csi 80 yr ♀️ 3/12 h/o rapid progressive R hip j pain Struggling w walking & feels it giving way Clinically the joint is v irritable XR reports bilateral mild OA CV disease USS (not that it's needed) below Main differential?!

Enjoyed writing this article!

What do standup comedians & sports docs have in common? We both hear a lot of groaning; 1 from the audience the other from dodgy hamstrings 8 years of laughs, late fitness tests & questionable rehab chat with Josh Pugh Brilliant player, even better comic…average patient

Consent ✅️ 48yr roofer c/o lateral ankle pain & flicking 1y post fall MRI: peroneal tendinopathy US: peroneus brevis subluxation on DF—snaps back on PF Painful! Likely retinaculum tear Referred to Ortho for repair Surgical success rate? Mark Farndon @yorfac

Sudden vasoconstriction and then vasodilation affecting the anterior cerebral artery and trigeminal nerve Gets me every time!!🍦❄️ 😫

Systemic Lupus Erythematosus

🦶🏽ACHILLES RUPTURE… or is it? 🤔 55M treated conservatively after pothole injury 3yrs later, still struggling—referred to SEM POCUS: large bony fragment, not rupture Likely avulsion #, not tendon rupture Early POCUS could’ve changed everything Consent ✅

Lobe sided unicornitis

I've been waiting all my life for this tweet James Noake #e45

New paper in British Journal of Sports Medicine (BJSM) out now: “Optimising neck training to reduce head acceleration events in sport” Systematic review + Delphi = 57 key recommendations across: ⚠️ Context ⚠️ Periodisation ⚠️ Adaptations ⚠️ Content ⚠️ Adherence Neck strength 👍🏽👍🏽 doi.org/10.1136/bjspor…

👣 "Pebble under my foot" ≠ always neuroma Pain under 2nd MT head, clawing 2nd toe + Mulders Booked for US-guided injection… but no neuroma It’s a bursitis from hammer toe deformity Steroid = short-term fix + fat pad risk She needed podiatry, not a needle Consent ✅

Every day’s a school day 🚸 Post-rupture Achilles ossification (aka heterotopic ossification): bone forms in the tendon, similar to myositis ossificans. More common in males, can occur in first 6 wks post-injury—linked to early loading. Often asymptomatic but may need surgery.

🖐🏽 De Quervains Tenosynovitis is often considered as a differential diagnosis of radial wrist pain But what does it actually look like on ultrasound? ➡️ If these findings aren't present- it isn't De Quervains Consent ✅️