28 Curr Rev Musculoskelet Med (2009) 2:25–29 Fig. 3 Long-axis scan of a hand injury showing a fracture of the left second metacarpal bone The fracture is visualized as a disruption of the hyper- echoic cortical surface, speciﬁcally as a separation or step- off deformity along the cortical surface (Fig. 3). Case 2 The second case shows the mechanism of injury, US probe placement, and the resultant sonographic image seen in a snowboarder suffering an acute subscapularis tendon tear, a rotator cuff injury (Figs. 4, 5, 6). Fig. 4 Mechanism of shoulder injury in a snowboarder falling backwards Fig. 5 Short-axis sonographic view showing the patient with the shoulder being evaluated in an externally rotated position Fig. 6 Short axis sonographic shoulder view showing an acute subscapular tendon tear Case 3 This case shows one of the authors (Kirkpatrick AW) using portable ultrasound mountainside to evaluate the injury suffered to the knee of a snowboarder. This demonstrates the feasibility of actually doing real time ultrasound eval- uation at or near the site of injury (Fig. 7). Conclusions Snowboarding, whether at the elite or recreational level, is associated with signiﬁcant injuries involving the abdomen, chest, head, and extremities. Portable mountainside US has the potential to accurately identify the extremity injuries