Diagnostic ultrasound of muscle injuries: what the sports medicine clinician should know

Muscle injuries are among the most prevalent musculoskeletal conditions in athletes, contributing significantly to morbidity and time lost from competition. The use of ultrasound (US) is advantageous in assessing these injuries due to its low cost, accessibility, portability, dynamic real-time capabilities and utility in prognosis and rehabilitation planning. This state-of-the-art review offers a comprehensive synthesis of current evidence on the anatomical, technical and clinical aspects of diagnostic US in evaluating sports-related muscle injuries. Key topics include the differentiation between direct and indirect injury mechanisms, classification systems, prognostic indicators and common complications such as fibrosis, haematoma and myositis ossificans. Emphasis is placed on a practical, stepwise approach to US examination and reporting, incorporating anatomical detail and functional assessment to support individualised return-to-play decisions. Despite certain limitations, the US remains a cornerstone imaging modality in sports medicine. Emerging technologies, including advanced imaging techniques, hold promise for enhancing diagnostic accuracy and optimising clinical outcomes.