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With careful probe placement and beam incidence, discontinuities or buckling of the bone's accessible surfaces are readily identified. This may present as a small discontinuity in the normally continuous hyperechoic contour or overt displacement and step formation (Figure 33.4) with or without the presence of haemorrhage (adjacent hypoechoic area) (Figure 33.5a). Variable hyperechoic deposits, contiguous with the bone surface, consistent with periosteal new bone or callus (woven bone) formation, may be present in stress fractures. Assessment of adjacent soft tissues for evidence of concurrent injury to an enthesis, muscle, joint capsule or the articular cartilage should be routine.