Artificial intelligence and automated pattern recognition, in particular, have been described as the next frontier in musculoskeletal imaging. However, as the initial hype phase transitions into clinical reality, an essential evaluation of these technologies is required. This narrative review examines the dichotomy between a potential future in which artificial intelligence offers unprecedented efficiency in automatizing multiple tasks in musculoskeletal radiology, from fracture detection, automated segmentation, to automated reporting, versus the hype, characterized by deep learning models that lack generalizability across different scanner vendors and patient populations. We explore the black box nature of deep learning and the ethical implications of automation. By analyzing current barriers to deployment, including workflow integration and regulatory hurdles, this article argues that although artificial intelligence holds transformative potential for musculoskeletal radiology, its success depends on moving beyond narrow diagnostic tasks toward robust multi-institutional validation, to evolve from a speculative trend into an essential clinical copilot tool.

Percutaneous interventional spine procedures are continually evolving. This article explores the current status, evidence, and controversial aspects of seven prominent image-guided minimally invasive interventions for painful spinal conditions: vertebral augmentation, basivertebral nerve ablation, interspinous process devices, minimally invasive lumbar decompression, radiofrequency medial branch ablation, high-frequency spinal cord stimulation, and multifidus muscle stimulation.

Elbow injuries resulting from acute trauma or repetitive overuse are a common source of pain and functional limitation in both athletes and the general population. This review presents a radiologic approach to the evaluation and management of these conditions. It describes the roles of key imaging modalities and provides practical guidance for assessing traumatic injuries such as fractures, ligamentous disruptions, and tendon avulsions. Common overuse conditions, such as medial epicondylitis, lateral epicondylitis, and nerve compression syndromes, are reviewed with attention to characteristic imaging features and diagnostic challenges. The article also explores the role of image-guided interventions, particularly ultrasound-guided injections, in both diagnosis and treatment. By consolidating imaging strategies and emphasizing the strengths of each modality, this review will help radiologists and clinicians achieve an accurate diagnosis and manage elbow injuries effectively, ultimately promoting better outcomes and a timely return to activity.

Injury patterns in children differ from those in adults because of the physiology of the immature skeleton. A tailored imaging approach and in-depth knowledge of the physiology and pathology of the immature musculoskeletal system are essential for diagnosis, guiding the clinician to the right treatment plan and preventing long-term complications. This review provides a comprehensive overview of pediatric sports injuries, structured by tissue type and anatomical region. We pay special attention to the physiology of the immature musculoskeletal system, epidemiology of pediatric sport injuries, advanced imaging techniques, differentiation between normal developmental variants and pathology, and recognition of conditions that may mimic sports injuries. By integrating anatomical insight with clinical relevance, this review offers a modern multidisciplinary guide to the challenges of pediatric sports imaging.

Traumatic and overuse injuries of bones and tendons of the wrist represent a significant proportion of the musculoskeletal disorders encountered in both athletic and occupational settings. Conventional radiography remains the first-line imaging modality for osseous trauma, but it can miss up to a third of scaphoid and hamate fractures. Computed tomography is superior for characterizing occult or nondisplaced fractures. Magnetic resonance imaging provides important information on occult fractures, overuse injuries of osseous structures, and tendinous abnormalities.A comprehensive understanding of wrist injuries is essential to ensure accurate and timely diagnosis, in turn facilitating the selection of appropriate patient-specific treatment strategies. By minimizing diagnostic delays, clinicians can reduce the risk of adverse sequelae such as chronic instability, degenerative joint changes, and functional impairment. The implementation of optimized diagnostic and therapeutic pathways not only lessens the long-term burden of disability for patients, but it also plays a crucial role in enabling a safe and efficient return to both occupational duties and sporting activities.

Disorders of the extensor mechanism of the wrist and hand are frequently encountered in clinical practice and observed more commonly than pathologies affecting the flexor system. When unrecognized or inadequately treated, these conditions may lead to substantial functional impairment and suboptimal clinical outcomes. Extensor tendon pathologies encompass a wide range of etiologies, such as repetitive overuse, acute trauma, inflammatory arthropathies, and degenerative tendinopathies. Accurate diagnosis depends on a thorough clinical evaluation, supported by high-resolution imaging. Ultrasound and magnetic resonance imaging are particularly useful for assessing tendon structure, surrounding soft tissues, and dynamic abnormalities. This review offers an updated overview of extensor tendon disorders of the wrist and fingers, focusing on their underlying causes and key imaging findings on magnetic resonance imaging and ultrasound to support an accurate and efficient diagnosis by radiologists.

Errors are an unavoidable aspect of medical practice, and radiology is no exception. In musculoskeletal radiology, the complexity of anatomy, subtle imaging findings, and cognitive biases contribute to significant challenges in diagnostic accuracy. This article examines personal experiences with diagnostic cognitive and perceptual errors, identifying key lessons learned and strategies to mitigate future mistakes through case-based analysis. It highlights recurring themes such as overreliance on prior reports, failure to consider contradictory clinical evidence, and premature diagnostic conclusions. Key strategies for improvement are structured reasoning processes, active hypothesis testing, continuous education, and fostering a culture of collaborative learning. The integration of artificial intelligence in radiology is also emphasized as a valuable tool to enhance diagnostic accuracy and streamline workflows.By addressing errors proactively and adopting evidence-based strategies, radiologists can cultivate a positive, supportive environment that prioritizes continuous learning, clear communication, and diagnostic excellence. This article serves as a reminder that errors, although inevitable, offer opportunities for professional growth and systemic improvement in patient care.

Non-neoplastic and noninfectious subchondral bone lesions incorporate several entities: acute traumatic injuries, insufficiency and fatigue fractures, primary or secondary osteonecrosis, osteochondritis dissecans, subchondral abnormalities related to cartilage loss, and marrow changes accompanying disuse or other causes of accelerated bone remodeling. Differentiating these conditions on imaging can be challenging due to overlapping imaging features, technical aspects, and insufficient clinical history. This review discusses how to avoid common mistakes in the imaging diagnosis of subchondral lesions, focusing on descriptive terminology, imaging scenarios, and reporting key imaging features that affect prognosis in these lesions.

Ankle and foot injuries are extremely common among athletes and nonathletes alike. Clinical findings are often nonspecific, and many injuries are difficult to diagnose with imaging, even using advanced techniques, and a delay in diagnosis may have significant adverse long-term consequences. Thus it is important to be familiar with the location and imaging appearances of these injuries. This article addresses several injuries that are commonly missed when imaging the ankle and foot.