Ultrasound (US) is a low-cost and radiation-free imaging modality that is commonly used in clinical practice. Diagnostic musculoskeletal ultrasound and US-guided procedures have become more prevalent in rheumatology practice due to advancements in US technology. As in diagnostic US, procedures in rheumatology have expanded their indications [1], with US guidance used not only for joint aspirations and injections but also for various other procedures such as tendon sheath injections [[2], [3], [4], [5], [6], [7], [8]].

When compared with blinded procedures using anatomic landmarks, randomized controlled trials (RCT) have confirmed that US-guided procedures typically rendered more safe, accurate, and effective interventions [9]. The number of published articles regarding US-guided procedures in rheumatology has significantly increased over the most recent 2 decades when searched in PubMed with the following searching strategy: (((“Ultrasonography, Interventional"[MeSH]) OR (“ultrasound-guided"[Title/Abstract])) OR (“ultrasound guidance"[Title/Abstract])) AND ((“Musculoskeletal Diseases"[Mesh]) OR (“Connective Tissue Diseases"[Mesh])) (Searched on March 1, 2023) (Fig. 1).

Herein we summarize fundamental practical knowledge with updated evidence about US-guided joint aspirations and injections as well as other procedures for tendons, nerves, and other structures. Clear instructions on the fundamental procedures for each joint are accompanied by various figures for facilitating better understanding and supplemented by practical tips based on our expertise. Emerging applications, such as fascia hydrorelease (FHR), are also described.