Therapeutic Ultrasound for Musculoskeletal Pain: A Critical Narrative Review of Clinical Outcomes, Treatment Parameters, and Reporting Quality

Background/Objectives: Therapeutic ultrasound (TUS) remains widely used for musculoskeletal pain despite inconsistent findings and variation in treatment protocols. This critical narrative review synthesized clinical evidence across selected musculoskeletal conditions and examined whether variation in treatment parameters and reporting quality may contribute to heterogeneous clinical outcomes. Methods: A targeted search of PubMed/MEDLINE, Scopus, and Web of Science was supplemented by reference-list screening and a pre-submission PubMed update on 29 September 2026. Clinical and methodological evidence was critically synthesized with reference to SANRA criteria. Results: The most consistent short-term signals of benefit were identified for knee osteoarthritis, calcific rotator cuff tendinopathy, and selected presentations of myofascial pain syndrome. Evidence for carpal tunnel syndrome remained conflicting, while evidence did not support routine use for chronic nonspecific low back pain. No consistent parameter–outcome pattern or universal dose–response relationship could be established. Interpretation was limited by protocol heterogeneity, co-interventions, incomplete parameter reporting, and limited information on device calibration. Conclusions: TUS may have an adjunctive role in selected indications but should not replace interventions with stronger evidence, particularly therapeutic exercise and patient education. Future studies should use verified acoustic exposure, standardized reporting, credible sham procedures, controlled co-interventions, and clinically meaningful longer-term outcomes.