Ultrasound is the most widely used medical imaging modality, yet the images it produces are fundamentally unique, arising from tissue-dependent scattering, reflection, and speed-of-sound variations that produce a constrained set of characteristic textures that differ markedly from natural-image statistics. These acoustically driven patterns make ultrasound challenging for algorithms originally designed for natural images. To bridge this gap, the field has increasingly turned to foundation models, hoping to leverage their generalization capabilities. However, these models often falter in ultrasound applications because they are not designed for ultrasound physics, they are merely trained on ultrasound data. Therefore, it is essential to integrate ultrasound-specific domain knowledge into established learning frameworks. We achieve this by reformulating self-supervised learning as a texture-analysis problem, introducing texture ultrasound semantic analysis (TUSA). Using TUSA, models learn to leverage highly scalable contrastive methods to extract true domain-specific representations directly from simple B-mode images. We train a TUSA model on a combination of open-source, simulated, and in vivo data. The latent space is compared to several larger foundation models, demonstrating that our approach gives TUSA models better generalizability for difficult downstream tasks on unique online datasets as well as a clinical eye dataset collected for this study. Our model achieves higher accuracy in detecting COVID (70%), spinal hematoma (100%) and vitreous hemorrhage (97%) and correlates more closely with quantitative parameters like liver steatosis (r = 0.83), ejection fraction (r = 0.63), and oxygen saturation (r = 0.38). We open-source the model weights and training script: https://github.com/talg2324/tusa