Background: Musculoskeletal ultrasound (MSK-US) has become an increasingly popular tool in diagnosing and managing musculoskeletal disorders due to its non-invasive, cost-effective, and real-time imaging capabilities as a practical alternative to conventional methods like MRI. Methods: This systematic review evaluates the effectiveness of MSK-US in orthopedic physiotherapy, adhering to PRISMA guidelines and using the PICO framework. Databases, including PubMed, Cochrane Library, ScienceDirect, ClinicalTrials.gov, Google Scholar, and PEDro, were searched for studies published between January 2001 and September 2024. Results: Nine studies, comprising case reports, clinical trials, and observational studies, were included. MSK-US demonstrated a significant reduction in repeat reduction rates (9.2% vs. 24.6%; P = .019) and improved volar tilt measurements (7.6° vs. 3.7°; P = .000). Its use was also effective in imaging muscle tears and treating hemiplegic shoulder pain, with high sensitivity and specificity in diagnosing fractures, although accuracy varied depending on the fracture site. Conclusion: Most studies presented a low to moderate risk of bias, according to quality assessments. MSK-US provides high diagnostic accuracy, with sensitivity and specificity rates of 87.3% and 96.4%, respectively, alongside therapeutic benefits and noninvasiveness. These attributes make it a valuable tool in orthopedic physical therapy. However, its effectiveness is highly operator-dependent and condition-specific. Further high-quality randomized controlled trials are necessary to fully validate these findings and confirm MSK-US as an integral tool in orthopedic practice.