Musculoskeletal sonography is a valuable diagnostic tool, but it comes with various pitfalls that can lead to errors. These pitfalls arise from similar sonographic properties of different tissues, nonintuitive anatomy, and anisotropy, which affects the appearance of tendons and ligaments. Common issues include mistaking normal structures for pathologic ones, such as differentiating between tendons and bursa in the shoulder or distinguishing between the median nerve and flexor tendons in the wrist. Awareness and understanding of these challenges, along with a systematic examination approach, can enhance diagnostic accuracy and reduce errors.
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