Musculoskeletal Ultrasound: Shoulder, Knee, Tendon and Joint Scans

Musculoskeletal ultrasound, often shortened to MSK ultrasound, examines soft tissues such as tendons, muscles, ligaments and nerves. A shoulder, knee, ankle or wrist scan is directed at a particular clinical question; it is not a guarantee that every possible cause of pain will be visible.

What can an MSK ultrasound investigate?

Examples include rotator-cuff or Achilles-tendon problems, muscle tears, fluid collections, joint or bursal inflammation, ganglion cysts and some nerve entrapments. Ultrasound can also help assess certain superficial lumps. The referring clinician should identify the painful area and the suspected problem so the examination can be targeted.

Why might I be asked to move during the scan?

The examiner can watch a tendon or other soft tissue while it moves. BMUS describes changing position or moving a joint as part of some musculoskeletal examinations. Tell the examiner which movement causes the symptoms and if a position is painful. Do not force a movement beyond what you can comfortably manage.

Ultrasound vs MRI or X-ray

Ultrasound is particularly useful for accessible soft tissues and dynamic assessment. It has difficulty looking through bone and cannot show the inside of adult bones in the same way as other imaging methods. Deep structures may also be difficult to assess. MRI or another examination may be appropriate when the question extends beyond what ultrasound can answer.

The useful question is not which scan is always “best,” but which structure and suspected injury the clinician needs to assess. If further imaging is requested, ask what additional information it is expected to provide.

Diagnostic scan or ultrasound-guided injection?

Ultrasound may guide a needle for joint injection or fluid aspiration. Newcastle Hospitals describes its use for directing treatment to a selected area. This is a procedure as well as imaging, so confirm whether your appointment is for assessment alone or includes a planned intervention. Ask about consent, medicines and aftercare before attending.

Preparation and results

Routine MSK ultrasound generally requires no special preparation. Wear clothes that allow access to the area and bring previous imaging and the referral. A useful symptom history includes where the pain occurs, whether it followed an injury and which activities provoke it.

Ask whether the result explains the symptoms, whether the examination had limitations and what follow-up is recommended. A report should inform the treatment discussion; it is not a reason to choose an exercise programme or injection on your own.

Clinics comparing an ultrasound machine should have their MSK operator specify probe and workflow requirements. Our buying guide explains how to document those requirements before ordering.

Infant hip screening answers a different question from an adult tendon or joint scan. The baby hip ultrasound guide explains DDH assessment and follow-up.

Sources

ACR/RSNA: musculoskeletal ultrasound; BMUS: what to expect at an MSK scan; Newcastle Hospitals: musculoskeletal ultrasound. Reviewed 13 November 2026. General education; individual findings need clinical interpretation.