Musculoskeletal ultrasound is the first-line imaging test for most soft tissue problems in the limbs. It shows tendons, muscles, ligaments, nerves and bursae in real time, it can image a joint while it moves, and it can guide a needle precisely into the structure being treated. What it cannot do is see inside bone or deep inside a joint — and knowing that boundary is what makes it useful rather than frustrating.
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Musculoskeletal ultrasound uses high-frequency sound waves to image the soft tissues of the limbs. Because these structures sit close to the surface, a high-frequency probe resolves them in fine detail — often finer than MRI for superficial tendons.
Three things distinguish it from other imaging:
There is no radiation, no injection in a standard scan, and no enclosed scanner.
| Structure | What can be identified |
|---|---|
| Tendons | Tendinopathy, partial and full-thickness tears, calcific deposits, subluxation |
| Bursae | Bursitis, fluid distension, thickening |
| Muscles | Tears, haematoma, hernia through fascia |
| Joints | Effusion, synovial thickening, active inflammation on Doppler |
| Nerves | Compression and swelling — for example the median nerve at the carpal tunnel |
| Ligaments | Superficial ligament tears, such as the collateral ligaments |
| Soft tissue lumps | Cysts, lipomas, ganglia — and whether a lump is solid or fluid-filled |
| Foreign bodies | Splinters and glass, including material that does not show on X-ray |
| Factor | Ultrasound | MRI |
|---|---|---|
| Superficial tendons | Excellent resolution | Excellent |
| Dynamic assessment | Yes — imaging during movement | No |
| Guided injection at the same visit | Yes | No |
| Deep joint structures (menisci, labrum, cruciates) | No | Gold standard |
| Bone and bone marrow | No | Yes |
| Claustrophobia or metalwork | Not an issue | May be a problem |
| Cost | £235 | Higher; not offered at our clinic |
The two are complementary rather than competing. Ultrasound answers most soft tissue questions quickly and cheaply; MRI answers the questions ultrasound cannot reach.
Stated plainly, because booking the wrong test wastes your time and money:
Our comparison of ultrasound, MRI, CT and X-ray sets out the wider picture.
Because ultrasound shows the needle in real time, it can be used to place an injection precisely into a joint, bursa or tendon sheath rather than estimating the position from surface landmarks. It can also be used to aspirate fluid or a cyst, and to needle a calcium deposit.
We cover the evidence in ultrasound-guided injections: why guidance matters. Injections start from £250.
| Area | Read the guide | Book a scan |
|---|---|---|
| Shoulder | Shoulder pain | Shoulder ultrasound |
| Elbow | Tennis vs golfer’s elbow | Elbow ultrasound |
| Wrist and hand | Wrist and hand pain | Wrist ultrasound |
| Hip and groin | Hip and groin pain | Hip ultrasound |
| Knee | Knee pain | Knee ultrasound |
| Ankle and Achilles | Achilles tendon pain | Ankle ultrasound |
| Foot | — | Foot ultrasound |
See a doctor rather than booking a scan if you have: pain following significant trauma, especially if you cannot weight-bear or use the limb; a hot, red, swollen joint with fever; new numbness, weakness or loss of bladder or bowel control; unexplained weight loss or night sweats with joint pain; or a history of cancer with new bone pain.
The most common reason patients come to us for a second-opinion MSK scan is a previous injection that did not work.
In the majority of these cases, the original injection was performed using anatomical landmark guidance — a technique that relies on the clinician’s estimate of where the target structure lies, rather than direct visualisation. When we rescan these patients, we frequently find that the injection was placed adjacent to, but not within, the target structure. Ultrasound guidance eliminates this uncertainty.
Describes general patterns across the patients we scan, not any individual case.
Shoulder, elbow, wrist and hand, hip and groin, knee, ankle and Achilles, and foot. We also assess soft tissue lumps anywhere on the body.
Neither is better overall — they answer different questions. Ultrasound is superior for superficial tendons, for dynamic assessment and for guiding injections. MRI is required for menisci, cruciate ligaments, the hip labrum, bone and bone marrow.
No. You can book any MSK ultrasound directly with us, and we can send the report to your GP, physiotherapist or consultant at your request.
Where it is clinically appropriate, yes. The decision is made after the scan findings rather than before, because the scan sometimes shows the injection is not the right treatment.
Not reliably. Ultrasound does not image bone well. If a fracture is suspected, an X-ray is the correct first test.
Most MSK scans take 20 to 30 minutes. A scan is £235. You receive instant verbal results at the appointment from the consultant performing your scan, with the written report following within 24 hours.
CQC-registered clinic · HCPC-registered sonographers · BMUS member · ICO-registered. Reports can be shared securely with your NHS GP or specialist at your request.
Related: how to prepare for your ultrasound scan.
