OBJECTIVETo determine the practical applications of musculoskeletal ultrasound (MSK US) in the precise diagnosis and optimal interventional management of painful musculoskeletal conditions within Physical Medicine and Rehabilitation (PMR) clinics in Pakistan.STUDY DESIGNAn observational study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Combined Military Hospital, Mangla, Pakistan, from January 2023 to March 2024.METHODOLOGYA total of 402 patients presenting in the PMR pain clinic who underwent diagnostic MSK US examination and/or interventional procedure under ultrasound (US) guidance during year 2023-24, were enrolled. All US examinations and procedures were performed after getting written informed consent from the patients. The collected data were analysed to see the pattern of the most commonly presenting MSK diagnoses and the utility of US in the identification and treatment of diverse pain disorders.RESULTSA total of 402 patients including 238 (59.2%) males and 164 (40.8%) females with a mean age of 51.2 years (ranging from 15-92 years) were examined using US. The main diagnoses were knee osteoarthritis (26.4%), rotator-cuff syndrome (18.9%), and adhesive capsulitis (12.9%). The US-guided interventions were categorised into three main groups including the joints (33.8%), soft tissues (50.5%), and peripheral nerves (15.7%). Among the patients presenting at the PMR pain clinic for MSK US, 75.1% culminated in interventions, whereas 24.9% were treated conservatively.CONCLUSIONMusculoskeletal US is a time-efficient and reliable entity to diagnose and treat common pain disorders and help PMR clinicians to confirm the clinical diagnoses promptly and guide the needle while avoiding iatrogenic damage to the surrounding vital structures.KEY WORDSMusculoskeletal, Ultrasound, Interventional, Pain disorders, PMR clinic, Pakistan.