Musculoskeletal imaging: when scans help and how GPs decide

Musculoskeletal symptoms such as joint pain, muscle strain and tendon problems are extremely common. Most do not require imaging. When scans are used, it is to answer a specific clinical question and help guide management rather than to confirm pain itself.

This page explains how GPs decide when musculoskeletal imaging is appropriate, which scans are commonly used, and how results are interpreted in context.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help or advice on medical scans, please book a GP appointment.

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The GP approach to musculoskeletal symptoms

Initial assessment focuses on:

Symptom location, duration and pattern
History of injury or overuse
Impact on function and mobility
Red flags such as trauma, infection or neurological symptoms
Response to initial treatment

Imaging is considered when symptoms are persistent, atypical, or suggest a structural problem that would change management.

When musculoskeletal imaging is commonly helpful

Musculoskeletal imaging is more likely to be useful when:

Symptoms persist despite appropriate treatment and rehabilitation
There is a history of significant trauma
A specific structural injury is suspected
There are neurological features such as weakness or progressive numbness
Inflammatory or infective causes are suspected
Imaging will guide referral or treatment decisions

Imaging is not routinely needed for early or uncomplicated pain.

Common musculoskeletal imaging tests and how they are used

X-ray imaging

X-rays are often used as a first step when bone involvement is suspected.

They may help assess:

Fractures or dislocations
Advanced osteoarthritis
Alignment and joint space changes

X-rays do not show soft tissues such as muscles, tendons, ligaments or discs well.

Ultrasound imaging

Ultrasound is particularly useful for soft tissue assessment.

It may be used to assess:

Tendon injuries or inflammation
Bursitis
Rotator cuff problems
Soft tissue swellings or fluid collections

Ultrasound is dynamic and can assess structures during movement in some cases.

MRI scans

MRI provides detailed images of soft tissues and joints.

It may be used to assess:

Ligament or meniscal injuries
Disc and nerve involvement in selected cases
Persistent joint symptoms not explained by X-ray
Complex or unclear presentations

MRI is not routinely recommended for early back pain or uncomplicated joint symptoms.

How GPs choose the right musculoskeletal scan

The choice of imaging depends on:

The suspected underlying cause
Whether bone or soft tissue is the main concern
Duration and progression of symptoms
Whether results will change management or referral
Safety considerations

For broader decision-making, see:
How GPs use medical imaging in practice

Common conditions where musculoskeletal imaging may be considered

Examples include:

Suspected fractures
Persistent shoulder pain with reduced function
Suspected meniscal or ligament injury
Unexplained joint swelling
Suspected inflammatory arthritis
Red-flag back pain features

Many musculoskeletal problems are managed safely without imaging.

Seek urgent medical advice if you develop:

Severe pain following trauma with inability to move or weight bear
New weakness, numbness, or loss of bladder or bowel control
A hot, swollen joint with fever
Rapidly worsening pain with systemic symptoms

Limitations of musculoskeletal imaging

Imaging findings do not always explain pain
Degenerative changes are common and often incidental
Normal scans do not rule out functional pain
Over-imaging can delay effective rehabilitation

Results should always be interpreted alongside symptoms and examination.

What happens after musculoskeletal imaging

If imaging explains symptoms

A GP may:

Confirm the likely diagnosis
Recommend targeted rehabilitation
Adjust treatment
Refer to physiotherapy, orthopaedics or rheumatology where appropriate

If imaging is normal