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These 10 free MSK-LE questions are organized by exam domain, so you can see how each part of the POCUS - Musculoskeletal Lower Extremity (MSK-LE) blueprint is tested. Reveal the answer and explanation under each question.
The still images look normal, but a dancer describes a reproducible snap behind the lateral malleolus when changing direction. There is no acute trauma or bony tenderness, and ankle movement is comfortable. Which acquisition is most likely to capture the symptomatic abnormality?
Correct answer: A - Transverse imaging of the retromalleolar fibularis tendons during resisted dorsiflexion and eversion.
The defining neck of a Baker's cyst is being sought during a posterior knee scan. Which anatomical interval should the examiner inspect?
Correct answer: B - Semimembranosus tendon and medial head of gastrocnemius.
After prolonged kneeling, a worker develops foot drop with weak ankle dorsiflexion and eversion. Short-axis ultrasound near the fibular neck identifies a focally enlarged fascicular structure. Tracing it proximally shows that the abnormality lies before its division into the superficial and deep branches that supply the lateral and anterior leg compartments. Which nerve is being followed?
Correct answer: A - Common fibular nerve.
During a scan for atraumatic medial ankle discomfort, a short segment of tibialis posterior appears dark where it curves behind the medial malleolus. The adjacent tendon has an organized fibrillar pattern, and no retracted end is visible. Only a longitudinal image has been obtained. Before this focus is reported as a tear, what should the examiner do?
Correct answer: D - Use heel-toe angulation and reassess the segment in two perpendicular planes.
A runner has plantar heel pain with the first steps each morning. At the medial calcaneal attachment, the plantar fascia measures 5.6 mm with calipers perpendicular to its surfaces. It is hypoechoic with reduced fibrillar definition, but no fiber gap is found in either plane. A radiograph also shows a small plantar calcaneal spur. The sonographic findings should be interpreted as:
Correct answer: C - Fascial changes supporting plantar fasciopathy in this clinical setting.
In a swollen knee, gentle compression displaces anechoic fluid within the suprapatellar recess, but frond-like hypoechoic tissue arising from the synovial lining remains in place. Doppler signals persist within that tissue in two planes after gain is reduced below the noise threshold. What accounts for the non-displaceable component?
Correct answer: A - Hypertrophied synovium with active perfusion.
A 44-year-old recreational basketball player felt a snap behind the ankle and cannot push off normally. Some active plantar flexion remains, but squeezing the calf produces no plantar flexion. Ultrasound in two planes shows retracted Achilles ends separated by fluid. A thin, continuous tendon runs along the medial side of the gap and is traced separately from the Achilles proximally. How should these findings be reconciled?
Correct answer: C - Complete Achilles rupture, with an intact plantaris tendon alongside it.
An otherwise healthy adult develops a warm, tender patch of shin erythema after a superficial abrasion. The patient is afebrile, vital signs are normal, and pain is proportionate to the local findings. A technically adequate scan shows subcutaneous cobblestoning without a focal collection, deep fascial fluid, or gas. What management is supported by this examination?
Correct answer: D - Treat cellulitis with antibiotics and clinical follow-up, without incision and drainage.
Lateral hip pain in a 58-year-old is reproduced by resisted abduction and lying on the affected side. Ultrasound shows a thickened, heterogeneous gluteus medius tendon at its greater-trochanter insertion, with continuity preserved in both planes. Only a trace of fluid is present in the adjacent bursa. Which working diagnosis best integrates the examination and scan?
Correct answer: B - Gluteus medius tendinopathy.
Narrow shoes provoke burning pain into the third and fourth toes, described as walking on a small pebble. Ultrasound of the painful third web space shows a poorly compressible hypoechoic nodule plantar to the deep transverse metatarsal ligament. The common plantar digital nerve can be followed into the nodule, and pressure directly over it reproduces the familiar symptoms. The most likely explanation for this lesion is:
Correct answer: D - Morton neuroma.
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