Musculoskeletal ultrasound (MSK-US) has evolved from a diagnostic tool into a key modality for guiding minimally invasive interventions across the musculoskeletal system. Its real-time imaging, portability, and absence of ionizing radiation make it a cost-effective and safe alternative to fluoroscopy and CT for numerous procedures, including biopsies, aspirations, injections, and percutaneous releases. Recent technological advances in ultrasound, including high-frequency probes, microvascular imaging, needle-tracking systems, and robotic probe steering, have improved precision and expanded its application to complex regions such as the spine and peripheral nerves. Minimally invasive ultrasound-guided techniques now play an important role in treating conditions such as De Quervain's disease, trigger finger, Dupuytren's contracture, carpal tunnel syndrome, and epicondylitis, offering outcomes comparable to surgery with reduced morbidity. Novel biological treatments, including platelet-rich plasma and mesenchymal stem cell therapies, show regenerative potential but require further validation. Despite ongoing debate about the long-term safety of corticosteroids and local anesthetics, ultrasound guidance continues to expand its role in interventional and regenerative medicine. The integration of advanced imaging technologies with standardized protocols and specialized training is expected to further consolidate ultrasound-guided interventions as a cornerstone of modern musculoskeletal care, improving both procedural safety and patient outcomes.
Keywords: image-guided therapy; interventional radiology; minimally invasive procedures; musculoskeletal ultrasound; ultrasound-guided interventions; ultrasound-guided surgery.
© The Author(s) 2026. Published by Oxford University Press on behalf of the British Institute of Radiology.