Regional musculoskeletal pain is one of the most common complaints in daily rheumatological practice. Conventional radiology remains the cornerstone of diagnostic imaging in these patients despite the advent of new, fascinating imaging techniques. Ultrasonography may have a relevant impact on final diagnosis or therapeutic choices. It is highly sensitive to the identification of fine, soft-tissue changes and it should be considered as an integral part of the clinical examination in most patients. Scintigraphy is indicated when multifocal processes have to be excluded and when high sensitivity is required. Computed tomography is an excellent tool for the assessment of osseous based abnormalities. Magnetic resonance has several characteristics of the ideal diagnostic tool. However, its appropriateness in the evaluation of many regional musculoskeletal conditions is a matter for discussion. An appropriate diagnostic programme for patients with regional musculoskeletal pain has to be focused on the strengths and weaknesses of various imaging techniques.