A lots of patient visits yearly to the emergency department (ED) for sports-related injuries, the majority of which are musculoskeletal in nature. Ultrasound is becoming the most widely used modality in the evaluation of tendon pathology even when other advanced imaging modalities are readily available. Ultrasound is also the first mode of imaging available for muscle evaluation and remains the most useful modality to follow muscular trauma over time. Ultrasound use has continued to expand, particularly in the pediatric population, in part due to physician and public awareness of the negative effects of radiation exposure from computed tomography (CT) scanning. In the emergency medical care setting, musculoskeletal ultrasound has been used in the evaluation of military personnel during combat, athletes on the sideline, and patients in remote settings with little or no access to standard imaging techniques. In the ED setting, musculoskeletal ultrasound has been shown to reduce the time to diagnosis, assist with difficult diagnoses, improve outcomes, and increase physician ease with musculoskeletal procedures. Ultrasound can be used to diagnose acute traumatic musculoskeletal pathology including fractures, joint effusions, and tears of tendons, ligaments, and muscles. It can also facilitate the diagnosis of acute inflammatory and infectious musculoskeletal pathologic states such as arthritis, tendinitis, tenosynovitis, myositis, and bursitis. Lastly, a number of musculoskeletal procedures can be performed with the aid of ultrasound guidance.