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

"It's the only imaging modality that you can create your own pathology with the flick of a wrist."

Tip the probe a few degrees off perpendicular and less sound comes back to it. Less sound back means a darker picture. A darker tendon reads as hypoechoic, and hypoechoic reads as torn. The image still looks fine. The finding is invented.

Colin Rigney and Ryan Martin spend this episode on the two things that decide whether you can trust what is on your screen: anisotropy, the artifact that fools everyone early and that experienced scanners turn into a tool, and the vocabulary underneath it — hyperechoic, hypoechoic, anechoic, homogeneous, heterogeneous — which most clinicians use loosely and the RMSK exam does not.

Also in this episode: how to toggle the probe to make peroneus longus and brevis wink at you one at a time, how far off 90 degrees you can be before it costs you (about five degrees, and it is obvious by fifteen), why the Achilles is the tendon most people position wrong, Dr. Joel Sellers' wall test for telling homogeneous from heterogeneous, what a denervated muscle looks like as it loses water and takes on fat, and why the contralateral side is the cheapest control you have.

The Monday-morning takeaway: put the tissue on tension before you judge it. A slack Achilles bows, a bowed tendon changes your angle, and a changed angle changes the diagnosis.

In this episode:
0:00 — Anisotropy, the artifact that fools you
0:54 — Welcome to From Probe to Practice
2:33 — The only modality where you can create your own pathology
3:32 — Why this shows up on the RMSK exam
3:56 — It clicks after the first 50 to 100 intentional scans
5:21 — What anisotropy actually is
6:41 — Using it on purpose: making the tendons wink
7:36 — Where it bites: supraspinatus, patellar, Achilles
7:56 — How far off 90 degrees can you be?
9:47 — Hyperechoic, hypoechoic, anechoic
12:32 — 256 shades of gray, and why it is all relative
13:40 — Patient positioning, starting with the Achilles
16:12 — Put the tissue on a stretch
19:01 — Homogeneous vs heterogeneous: the wall test
19:52 — Acute hematoma vs chronic ossification
20:59 — What a denervated muscle looks like
22:53 — Always check the other side
24:13 — RUSI, a topic for another day
26:32 — The machine will lie to you all day long

Mentioned in this episode:
Introduction to Musculoskeletal Ultrasound, the physics and machine-optimization course Ryan built: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/

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

"That's actually the easy part, is the injection. If you can't diagnose it, you can't inject it."

Dr. Greg Zakas trained in physical medicine and rehabilitation, did an interventional pain fellowship, and spent years in clinics where the model was opioids first and procedures second. He came out the other side as a full-time regenerative orthopedics physician. This is the whole route, told honestly — including the $400,000 of debt that shaped which specialty he picked, the forty-to-fifty-patient days that made real conversations impossible, and the VA research that settled the opioid question for him.

Colin Rigney and Ryan Martin take him through the part most clinicians get wrong: the assumption that ultrasound-guided injection is the hard skill. Zakas argues the needle work is the easy half. What separates practitioners is whether they can see the thing they are treating in the first place — and he makes the case that in trained hands, diagnostic ultrasound matches MRI for finding rotator cuff tears.

Also: why showing a patient their own tear on the screen builds more trust than any explanation, how the ability to talk about ultrasound and the ability to do it feed each other, why he refused to post about anything he had not seen dozens of times, and what he would tell a physician who is ten years behind him and wondering whether it is too late.

The Monday-morning takeaway: the diagnostic skill is the bottleneck, not the needle. If you are getting your orthobiologic into the joint but not to the lesion, more injection practice is not the fix.

In this episode:
0:00 — If you're not embracing it, you're going to be left behind
0:54 — How the three of us met
1:55 — PM&R, pain fellowship, and $400,000 of debt
2:22 — When prolotherapy was still considered voodoo
5:59 — Mission trips: Lima and Guadalajara
7:35 — Meet your hosts
11:42 — Why traditional pain medicine broke for him
12:52 — The VA study that changed his mind on opioids
15:30 — Insurance volume vs. time with a patient
16:17 — The slow pivot into orthobiologics
18:14 — Which courses were actually worth it
21:16 — The injection is the easy part
21:54 — Ultrasound vs MRI, and the naysayers
23:47 — What ultrasound does to patient trust
26:35 — Ultrasound as a communication tool
32:12 — Imposter syndrome and earning the right to teach
35:08 — What he's working on next
41:29 — Advice to a doctor ten years behind him
49:50 — Where to follow the work

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

Linear or curvilinear? Which frequency? And what should you actually be doing before the probe touches the patient?

Colin Rigney and Ryan Martin open From Probe to Practice with the decisions that quietly set the ceiling on every MSK ultrasound exam you run — probe selection, frequency, gain, and the positioning nobody talks about until an injection goes sideways.

Ryan's rule, from his mentor Wayne Smith: "Scan everything with a linear probe until you cannot." Colin's version of the same idea: "Ultrasound is an extension of your clinical brain." Both come back to intent — why are you scanning, and will it change what happens to this patient?

Also in this episode: a case from that same morning where a patient's anterior hip sat almost 12 cm deep and the linear probe simply could not reach it, why the curvilinear's crossing arrays can make a straight bone look curved, what to do when your clinic owns exactly one probe, and the scouting habit that prevents the most common avoidable injection problem.

The Monday-morning takeaway: always scout in the position you're going to inject in. A shoulder scouted seated and injected supine is a different shoulder.

In this episode:
0:00 — Ultrasound is an extension of your clinical brain
0:53 — Welcome to From Probe to Practice
1:51 — Before you touch the probe: why are you doing this?
3:02 — Scope of practice and clinical reasoning
4:24 — Optimisation starts before the patient
5:37 — Linear, curvilinear, hockey stick
6:32 — Use a linear probe whenever you can
7:03 — Trading depth for resolution
9:35 — The case that forced a curvilinear
10:51 — When you only have one probe
11:53 — The physics caveat nobody mentions
14:01 — Patient position, practitioner position
15:17 — Scout in the position you'll inject
16:02 — Start with why
17:18 — If you're not optimising the gain

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

"Whether you know it or not, you have a gap in your practice."

Colin Rigney and Ryan Martin — the founders of the Advanced MSK Ultrasound Center — introduce From Probe to Practice: what it is, who it's for, and why they built a show about musculoskeletal ultrasound that deliberately isn't a lecture.

This is not a 45-minute monologue on probe physics. It's two people who've trained clinicians for years talking about how MSK ultrasound actually works inside a practice — the diagnostic gaps nobody mentions, the injections that miss and why, the referrals you didn't need to make, the business of integrating it, and the case studies that only come from tens of thousands of reps. Plus, in Ryan's words, "a lot of dirt on each other."

Guests this season include Greg Zakas and Don Buford, among others from across regenerative and musculoskeletal medicine. Stay to the end for a look at what's coming.

In this introductory episode:
0:00 — The gap in your practice
0:12 — From Probe to Practice
0:30 — Who's talking
0:57 — What the show is
2:01 — Why it exists
2:23 — Who we made it for
3:07 — The moment you reach for it
3:45 — Why ultrasound, why now
4:37 — What this show is not
5:47 — What you can expect
7:37 — What one episode gets you
8:56 — Who else this is for
10:17 — The invitation
11:07 — This season on From Probe to Practice

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