Hi Linh,
That is a wonderful pick,
I have never diagnosed it with ultrasound before.
At the practice I work at we always perform a plain radiograph before we do any MSK ultrasound or injection. If they have had one in the last 6 months we are happy with that. If the referral doesn’t ask for one we do a self determined X-ray.
The reason we do this is highlighted by your example.
Plain radiographs are required to support MSK ultrasound in virtually all cases, otherwise you will often miss changes of arthritis, neoplasms, AVN etc.
To do MSK ultrasound without having a plain radiograph to review is a dangerous practice.
There are occasions when I may not have an X-ray available and I am always very careful to assess the bony surfaces. If something looks funny I will chat to my radiologist and ensure a radiograph is performed before proceeding.
Ultrasound certainly should not be the primary modality to make this diagnosis.
Steve